Oklahoma Licensed Case Manager

Job Summary

A company is looking for a Case Manager.

Key Responsibilities:

• Conduct timely medical necessity reviews using medical coverage guidelines to determine appropriateness of admission and level of care
• Communicate with payers and present cases to the Medical Director for determination on questionable admissions
• Complete continuous review and audit of patient treatment records to ensure compliance with regulations and prevent unnecessary procedures

Required Qualifications:

• Graduate from an accredited school of nursing required; Bachelor of Science in Nursing preferred
• Three years of clinical nursing experience in an acute care facility; experience with utilization review or case management preferred
• Current RN License issued by the Oklahoma State Board of Nursing or a current multistate Compact RN License (eNLC)
• Case management certification preferred
• Knowledge of third-party payer issues and Medicare guidelines