Case Manager- Utilization Review Coordinator
About The Position
Join Our Team at Oklahoma Heart Hospital (OHH) ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients’ journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we’re shaping the future of heart care in Oklahoma by serving the state and leading the nation. Location: South Campus- 5200 E. I-240 Service Road, OKC OK 73132 Shift: Monday through Friday, 2pm to 10:30 pm. No Weekends/ No Holidays Position will require an RN, Registered Nurse Licensure.
Requirements
- Graduate of an accredited school of nursing.
- Minimum of three (3) years hospital based nursing practice with experience in utilization/case management.
- Willing to pursue certification in Case Management (CCM).
- Proficient in computer usage.
- Registered Nurse with current Oklahoma licensure.
Nice To Haves
- Bachelors or Master’s degree a plus.
Responsibilities
- Responsible for comprehensive coordination of care and service of individual patients and/or patient populations, promoting effective utilization of resources, and assuming a leadership role on the multidisciplinary team to achieve patient and physician satisfaction and optimal outcomes.
- Responsible for all activities associated with the Utilization Review process.
- Must be able to work with all disciplines to meet patients’ needs from admission through discharge.
- Will perform duties and responsibilities in a manner consistent with the mission and values of the Oklahoma Heart Hospital.
- Performs admission review to assure patient is placed in correct level of care and concurrent or focused reviews using Medicare and payer specific criteria.
- Demonstrates an ability to identify cases where admission criteria not met. Contacts physicians for additional information and suggests alternatives if admission/continued stay is not appropriate.
- Knowledgeable on inpatient, observation and outpatient criteria.
- Knowledgeable of billing, payer contracts, agreements and reimbursement issues for services provided to OHH patients.
Benefits
- Medical, Dental, and Vision coverage
- 401(k) plan with employer match
- Long-term and short-term disability
- Employee Assistance Programs (EAP)
- Paid Time Off (PTO)
- Extended Medical Benefits (EMB)
- Opportunities for continuing education and professional growth
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
