Job: RN UM Reviewer

Jobing Description

At APS Healthcare, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission, quite simply, is to improve the health of those we serve. We have an exciting opportunity for a RN Utilization Management Reviewer based in our Oklahoma City office.

The RN UM Reviewer will complete electronic and telephonic reviews for inpatient and outpatient services. This is a full-time, 40 hour per week position. Hours are Monday - Friday from 8am-5pm. No weekends or holidays and full benefits.

Essential Functions:
Performs electronic Utilization Review for outpatient and inpatient services.
Certifies medical necessity through the use of criteria and nursing judgment.
Performs other clinically based activities to coordinates care.
Utilizes evidenced-based criteria for decisions.
Collects clinical data and enters information into database for tracking and metrics purposes.

Education:
Degree from accredited nursing program required. BSN preferred but not required,
Current, unrestricted Oklahoma RN license required.

Qualifications:
Minimum 3 years clinical experience.
Previous experience in utilization review, quality assurance, disease management or case management preferred.
Knowledge of chronic illness, co-morbidities, and general disease states.
Previous telephonic nursing experience preferred.
Strong computer experience with proficiency in Microsoft Office applications and navigating within on-line systems is essential.
Excellent customer service, verbal and written communication, and clinical assessment skills.
Ability to integrate data and evaluate to design meaningful educational interventions promoting successful outcomes.