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Utilization Review RN
1 month ago
Overview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care Management/Coordination Resource Management Transition Management and Denial Prevention Utilization Management Psychosocial Management Assist with establishing and review of departmental metrics on annual basis or as needed to insure mission, vision and strategic plan of NRHS. Qualifications: Education Diploma or Associates degree (ADN) required, Bachelor of Science in Nursing (BSN), or Master's of Science in Nursing (MSN) preferred. Experience 3 years of acute RN experience required. Prior Utilization Review experience preferred. Current knowledge of medical necessity guidelines for hospitalization status preferred. (Above requirements can be met by equivalent combination of education and experience) Licensure/Certification Current, RN license in the state of Oklahoma, Basic Life Support (BLS) training or retraining is required and must be maintained for the duration of employment. Compensation/Benefits $17.39-$28.40/hr depending on previous work experience. Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement. Utilization Review RN - Nights at Norman Regional Health System summary: The Utilization Review RN at Norman Regional Health System is responsible for ensuring compliance in the review process for admissions, focusing on medical necessity and appropriateness. The role includes clinical analysis, resource management, and advocacy while collaborating with healthcare teams to manage care transitions and prevent denials. Ideal candidates should have extensive RN experience, preferably in Utilization Review, along with a current nursing license and relevant certifications. Keywords: Utilization Review, Registered Nurse, Clinical Management, Healthcare Compliance, Patient Advocacy, Care Coordination, Medical Necessity, Nursing License, Transition Management, Denial Prevention
