Nurse Case Manager

6 days ago


Oklahoma City, Oklahoma, United States United Surgical Partners Full time
Job Summary

We are seeking a highly skilled and compassionate Nurse Case Manager to join our team at United Surgical Partners. As a key member of our healthcare team, you will play a vital role in ensuring the highest level of care and service for our patients and their families.

Key Responsibilities
  • Collaborate with healthcare professionals to assess, plan, and implement individualized care plans that meet the unique needs of each patient.
  • Utilize evidence-based criteria, such as InterQual and Milliman, to ensure medical necessity and quality of care.
  • Proactively communicate with physicians and other healthcare team members to ensure seamless care coordination.
  • Monitor patient admission status and communicate needs to attending physicians.
  • Review records and provide timely submissions to the Recovery Audit Contractor (RAC) as needed.
Requirements
  • Current Oklahoma RN license required.
  • Experience in InterQual or Milliman utilization preferred.
  • Recovery Audit Contractor process management and appeals experience preferred.
  • BLS certification within 90 days of hire.
Work Environment

Our team works in a temperature-controlled environment, and the employee must be able to read and speak English fluently. The job requires sitting for 70% of activities with minimal up and down activity. The employee may be exposed to computer screens for 6-7 hours per day, lifting up to 20-30 pounds, and potential exposure to blood and body fluids.

Qualifications
  • BLS certification within 90 days of hire.
  • Current Oklahoma RN license required.
  • Experience in InterQual or Milliman utilization preferred.
  • Recovery Audit Contractor process management and appeals experience preferred.

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