Case Manager- Utilization Review Coordinator
 Oklahoma Heart Hospital | |
paid time off, 401(k)
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 United States, Oklahoma, Oklahoma City | |
| 4050 West Memorial Road (Show on map) | |
 Jan 16, 2025 | |
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Overview 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. Why You'll Love Working Here: Comprehensive 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 Please note that benefits may vary by position, and some roles (like PRN, Flex, Float, etc.) may have exclusions. For eligible positions, benefits start on your first day! We can't wait for you to join our heart-centered team! 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. Qualifications Education: Graduate of an accredited school of nursing. Bachelors or Master's degree a plus. Experience: 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. Licensure/Certification: Registered Nurse with current Oklahoma licensure. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care. Learn more about diversity at Oklahoma Heart Hospital. As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.
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. Education: Graduate of an accredited school of nursing. Bachelors or Master's degree a plus. Experience: 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. Licensure/Certification: Registered Nurse with current Oklahoma licensure. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care. Learn more about diversity at Oklahoma Heart Hospital. As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care. | |