- CenterWell (Oklahoma City, OK)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Evolent (Oklahoma City, OK)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- SSM Health (Midwest City, OK)
- …and communicates with patient/family/caregiver and appropriate nursing, physician, and care management staff. + Utilizes research and other forms of evidence to ... + Participates in ministry and system-wide evaluation of resource utilization as it pertains to wound, ostomy, and continence...of the healthcare team as it relates to the management of wounds, ostomies, and continence. + Works in… more
- SSM Health (Oklahoma City, OK)
- …and communicates with patient/family/caregiver and appropriate nursing, physician, and care management staff. + Utilizes research and other forms of evidence to ... + Participates in ministry and system-wide evaluation of resource utilization as it pertains to wound, ostomy, and continence...of the healthcare team as it relates to the management of wounds, ostomies, and continence. + Works in… more
- Sharecare (Oklahoma City, OK)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Oklahoma City, OK)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- Oracle (Oklahoma City, OK)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more