Registered Nurse Utilization Review

Ascension•Claremore, OK

2d•Remote

About The Position

Ascension St. John Medical Center is seeking a Registered Nurse for Utilization Review to join their team remotely. This PRN position involves working every other weekend from 8 am to 4:30 pm. The role focuses on ensuring patient-centered care by validating medical necessity, advocating for benefits, and coordinating transitions to reduce readmissions. It also aims to maximize financial health by preventing claim denials and managing appeals, drive operational efficiency by coordinating with multidisciplinary teams, and uphold quality and compliance by enforcing clinical standards and payer regulations.

Requirements

Registered Nurse credentialed from the Oklahoma Board of Nursing obtained prior to hire date or job transfer date required.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Nice To Haves

Active Oklahoma Nursing License
3+ years of Nursing experience
Utilization Management experience preferred

Responsibilities

Secures Patient-Centered Care: Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
Maximizes Financial Health: Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
Drives Operational Efficiency: Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
Upholds Quality and Compliance: Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.