Utilization Management Nurse
Akron Children's Hospital · Tulsa, OK
Job description
Full Time Days 7am-4:30pm 40 Hours/Week Utilization management and pediatric nursing experience preferred Summary: The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices. Responsibilities: 1. Conduct Utilization Review & Determine Appropriate Level of Care Applies evidence-based medical necessity criteria, validates admission status, and ensures all inpatient, observation, and outpatient-in-a-bed cases meet criteria. Collaborates proactively with physician advisors and attending providers for accurate level-of-care decisions and authorization of hospital days. 2. Manage Denials, Compliance, and Quality Improvement Activities Participates in denial management and peer review processes, identifies compliance or ethical issues, and contributes to quality and safety initiatives aimed at improving departmental and hospital workflows. 3. Support Care Progression Through Interdisciplinary Collaboration Actively engages in daily huddles, multidisciplinary rounds, and patient care discussions to understand service intensity, discharge barriers, and progression of care, while serving as a resource to the care team on utilization, documentation, and admission requirements. 4. Maintain Accurate and Timely Documentation Clearly documents all reviews, interactions, and decisions in Midas, Epic, and other required systems. 5. Performs additional duties as assigned. Other information: Technical Expertise 1. Experience in inpatient clinical is required. 2. Experience in pediatrics is preferred. 3. Experience working with all levels within an organization is required. 4. Experience in healthcare is required. 5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required. Education and Experience 1.Education: Bachelor's in nursing [BSN] is required. For employees hired after July 1, 2013, BSN is required or must be obtained within 5 years from date of hire. 2. Certification: Registered Nurse licensure is required. 3. Years of relevant experience: 3 years is required. 4. Years of experience supervising: None. Full Time FTE: 1.000000 Status: Remote
More jobs in Tulsa, OK
Delivery Driver - Flexible Onboarding
DoorDash · Tulsa, OK
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
New CDL Positions Open. Great Benefits. Top Pay. Hiring Now. Apply Today!
Delivery Driver - Onboarding / Onboard
DoorDash · Tulsa, OK
Social security number (only in the US).
" Licensed Mental Health Counselor (LMHC) Wage: Up to $122/hour Licensed Mental Health Counselor — Are you ready to launch or expand your private practice? Headway is here to help you start accepting insurance with ease, increase your earnings with higher rates, and start taking covered clients sooner. It's all on one free-to-use platform, no commitment required. About you ● You're a fully-licensed Mental Health Counselor at a Master's level or above with LMHC, LPCMH, or LIMHP licensure (accepted on a state by state basis), a valid NPI number, and malpractice insurance. ● You're ready to launch a private practice, or grow your existing business by taking insurance. About Headway Your expertise changes lives. Taking insurance makes it accessible to those who need it most. Every mental health provider who goes in-network with Headway supports people who'd otherwise be forced to choose between paying out of pocket, or not getting care at all. We make that process seamless — empowering you to accept insurance with ease, so you can do what you do best. So far, we've helped over 50,000 providers grow their practices, reaching countless people in need. How Headway supports providers - Start taking insurance, stress-free: Get credentialed for free in multiple states in as little as 30 days and start seeing covered clients sooner. - Built-in compliance: Stay compliant from day one with audit support and ongoing resources. - Expansive coverage: Work with the plans that most clients use, including Medicare Advantage and Medicaid. - Increase your earnings: Secure higher rates with top insurance plans through access to our nationwide insurance network. - Dependable payments: Build stability in your practice with predictable bi-weekly payments you can count on. - Built-in EHR features: Manage your practice in one place with real-time scheduling, secure client messaging, end-to-end documentation templates, built-in assessments, and more. - Free continuing education: Nurture your long-term professional goals and earn CEUs with complimentary courses on Headway Academy. How Headway supports your clients ● Increased access: Headway makes it easier for your clients to get the care they need at a price they can afford through insurance. ● Instant verification: Clients can easily check their insurance status and get the care they need without disruption. Please note: At this time, Headway can't support mental health professionals that aren't fully licensed. If your application was rejected for incomplete licensure, you're welcome to reapply once you have a valid license. "