Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Palliative RN Care Manager
Oklahoma City, OK · On-site
$80 - $100/hr
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Palliative RN Care Manager
Oklahoma City, OK · On-site
$80 - $100/hr
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
... Manager is accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... utilization of healthcare resources. The primary responsibility of the role will be to assess, plan ...
Adult Care Management RN - Float (Full Time, Rotating Weekends) Department: OUMC Care Management ... utilization of healthcare resources. The primary responsibility of the role will be to assess, plan ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Field Medical Director, Vascular Surgeon
Oklahoma City, OK · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Field Medical Director, Vascular Surgeon
Oklahoma City, OK · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Case Manager II - PRN Days
Broken Arrow, OK · On-site
$19 - $25/hr
Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and ...
Case Manager II - PRN Days
Broken Arrow, OK · On-site
$19 - $25/hr
Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and ...
Adult Care Management Med Surge RN Department: OUMC Care Management New to OU Health? Ask your ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management Med Surge RN Department: OUMC Care Management New to OU Health? Ask your ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management Med Surge RN Department: OUMC Care Management New to OU Health? Ask your ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Adult Care Management Med Surge RN Department: OUMC Care Management New to OU Health? Ask your ... Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and ...
Manager Utilization Management information
What does a manager utilization management do?
A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the key skills and qualifications needed to thrive as a manager utilization management?
To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.
What are some common challenges faced by a manager utilization management, and how can they effectively address them?
Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.
What is the difference between Manager Utilization Management vs Utilization Review Nurse?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.
What are the most commonly searched types of Utilization Management jobs in Oklahoma?
The most popular types of Utilization Management jobs in Oklahoma are:
What are popular job titles related to Manager Utilization Management jobs in Oklahoma?
For Manager Utilization Management jobs in Oklahoma, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Oklahoma look for?
The top searched job categories for Manager Utilization Management jobs in Oklahoma are:
What cities in Oklahoma are hiring for Manager Utilization Management jobs?
Cities in Oklahoma with the most Manager Utilization Management job openings:
Other
Medical, Dental, Retirement, PTO
Posted 7 days ago
Job description
Position Title: Palliative RN Care Manager Department: OUMC Care Management Job Description: New to OU Health? Ask your recruiter about our competitive wages and total rewards package, including a sign-on bonus and possible relocation assistance if you are located outside of 100 miles! **This position may be filled as a Level 1, 2, or 3 depending on specific education, experience, and license requirements.** *Ideal candidate will have experience in a Palliative/Hospice care setting.* Care Management RNs are accountable and responsible for coordinating the care and services of selected patient populations and ensuring the efficient utilization of healthcare resources. The primary responsibility of the role will be to assess, plan, implement, coordinate, monitor, and evaluate the options and services required to meet the healthcare needs of patients, while promoting quality outcomes and patient satisfaction. Essential Responsibilities Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. Conduct comprehensive assessments of patients' health status, medical history, and ongoing care needs. Develop individualized care plans in collaboration with the interdisciplinary healthcare team, patients, and their families to ensure continuity of care. Provide education to patients and their families regarding their health conditions, treatment plans, medications, financial expectations, and self-care strategies. Coordinate and facilitate communication between patients, families, healthcare providers, and community resources to optimize patient care outcomes. Evaluate effectiveness of care plans and adjust as necessary. Evaluate healthcare utilization patterns and identify opportunities for improving efficiency and cost-effectiveness. Advocate for appropriate allocation of resources and services to meet patients' needs while adhering to regulatory guidelines and reimbursement criteria. Collaborate with insurance providers, social workers, and other stakeholders to ensure timely authorization of services and coverage for patients. Monitor and evaluate patient outcomes, healthcare processes, and care delivery systems to identify areas for improvement. Participate in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practices and enhance patient safety and satisfaction. Ensure compliance with federal, state, and local regulations, as well as accreditation requirements related to care management and patient care. Implement strategies to minimize readmissions, prevent complications, and optimize care planning processes. General Responsibilities Performs other duties as assigned. Minimum Qualifications (Level 1): Education Requirements: Associate’s degree in nursing required. Experience Requirements : Minimum of 0 - 3 years Nursing experience required, with Care Management experience preferred. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required Minimum Qualifications (Level 2): Education Requirements: Bachelor’s degree in nursing required. Experience Requirements: At least 3 years of Care Management experience. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required Minimum Qualifications (Level 3): Education Requirements: Bachelor’s degree in nursing required. Experience Requirements: At least 5 years of Care Management experience. License/Certification/Registration Requirements: Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)). Basic Life Support from the American Heart Association required Knowledge/Skills/Abilities Required Demonstrates expertise in regulatory requirements regarding the care management discipline. Strong communication, interpersonal, and leadership skills. Detailed oriented with excellent organizational skills. Commitment to fostering a culture of continuous learning, quality improvement, and patient-centered care. Strong assessment, critical thinking, and problem-solving skills Strong knowledge of healthcare regulations, including CMS guideline Show clear understanding of utilization management principles and integrate these with care management responsibilities. Serve as liaison between patients, families, and healthcare providers. Proficiency in utilizing electronic health records (EHR) and care management software. Strong assessment, critical thinking, and problem-solving skills. #cb Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.