This is a great opportunity for a UR professional who is looking for a new challenge. The UR Nurse Manager will work as a member of a single employer health plan in a non-traditional care management setting. A publicly traded, Tulsa headquartered energy company is looking to add a UR Nurse Manager to its health care team.
The UR Nurse Manager will provide plan participants with appropriate and comprehensive utilization of health care services and benefits as designated. This requires an experienced RN with a diverse clinical background as well as experience within the managed care industry and specifically in the self-funded arena. Will work with providers, hospitals and participants to achieve optimal outcomes and appropriate use of services and benefits. This position is performed on-site at the Tulsa office location. Remote or hybrid is NOT an option.
This position reports to the Health Plan General Manager and requires:
SUMMARY: The Utilization Review Nurse Manager manages daily activities within the Health Plan's Utilization Management function. Promotes the use of health care services or interventions that are necessary and appropriate, medically effective, and allowable under the Plan. Establishes and tracks performance against measures of productivity, efficiency, and effectiveness. Oversees the work of clinical staff that evaluates patient needs and determines medical necessity of care plans or accuracy of charges. Collaborates with internal Care Team Members and external care providers to develop care plans that balance care quality with care cost, ensuring appropriate usage of resources. Prepares reports summarizing utilization trends and identifies opportunities for utilization/cost reduction.
ESSENTIAL DUTIES AND RESPONSIBILITIES: The items listed below detail some of the assigned duties and responsibilities for this position. This is not meant to be an all-inclusive list, and management reserves the right to change these duties at any time.
QUALIFICATIONS: The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION AND EXPERIENCE
COMMUNICATION SKILLS
OTHER SKILLS
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