Oklahoma RN Case Manager

Job Summary

A company is looking for an RN Case Manager - Utilization Review.

Key Responsibilities:

• Conduct timely medical necessity reviews for patients to determine appropriateness of admission and level of care
• Communicate with insurance companies and present cases to the Medical Director for determination on clinical criteria
• Review treatment records and insurance denials to ensure compliance with regulations and attempt to overturn denials

Required Qualifications, Training, and Education:

• Graduate from an accredited school of nursing required; Bachelor of Science in Nursing preferred
• Three years of clinical nursing experience in an acute care facility; experience in utilization review or case management preferred
• Current RN License issued by the Oklahoma State Board of Nursing or a current multistate Compact RN License (eNLC)
• Case management certification preferred
• Knowledge of third-party payer issues and Medicare guidelines