RN Case Manager – Utilization Review

INTEGRIS Health

. Complete comprehensive assessments of patients’ clinical, psychological, and financial needs .

Posted 9/22/2026full-timeRemote • Oklahoma • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in patient assessment, discharge planning, and resource utilization while maintaining compliance with CMS, Medicare, and Medicaid regulations. Strong ability to communicate effectively with patients, families, and healthcare professionals to facilitate timely and appropriate care transitions.

Highest-signal resume keywords

Registered Nurse (RN) LicensureCase Management CertificationBLS CertificationPatient AssessmentResource Utilization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Patient AssessmentDischarge PlanningUtilization ManagementData CollectionQuality Improvement Reporting

Soft Skills

Interpersonal CommunicationCollaborationEffective Communication

Tools & Technologies

Electronic Health Records (EHR)Clinical Documentation Systems

Certifications & Qualifications

Registered Nurse (RN) LicensureBLS CertificationCase Management Certification

Industry Keywords

CMS RegulationsMedicareMedicaidManaged CarePayer Regulations

About the role

Key responsibilities & impact

Complete comprehensive assessments of patients’ clinical, psychological, and financial needs
Recommend and coordinate timely transfers to appropriate levels of care
Develop, implement, evaluate, and revise discharge plans, including referrals
Communicate discharge care plans and changes to patients, families, and healthcare professionals
Assist physicians and hospital staff with resource utilization and timely discharge planning
Coordinate services between hospital departments to facilitate patient discharge
Conduct concurrent reviews of patient records
Apply utilization criteria to determine appropriate resource utilization
Notify internal and external contacts about utilization issues affecting patient care or reimbursement
Facilitate patient transfers according to hospital policies and applicable regulations
Advise physicians on discharge planning, documentation, resource utilization, and reimbursement
Manage established pathways to enhance clinical effectiveness and resource management
Maintain knowledge of CMS, Medicare, Medicaid, managed care, payer regulations, and benefit limits
Educate patients, families, and healthcare professionals about payer regulations and benefits
Develop knowledge of hospital and community resources and facilitate appropriate levels of care
Identify opportunities to reduce care-management costs without affecting quality or outcomes
Collect and record data for utilization and Quality Improvement reporting
Collaborate with patients, families, physicians, hospital staff, and other care organizations

Requirements

What you’ll need

2 years experience in a clinical setting, such as home health, inpatient, physician office, or clinic
BLS (Basic Life Support) issued by American Red Cross or American Heart Association within 30 days of hire
Current Registered Nurse (RN) licensure in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state
Excellent interpersonal communication and collaboration skills
Computer experience
Effective communication in English, verbal and written
Current Oklahoma State Driver's License
Driving record acceptable to the employer's insurance carrier
Experience with managed care and payer/provider requirements preferred
Bachelor's of Science in Nursing preferred
Case Management Certification preferred

Benefits

Comp & perks

Front-loaded PTO
Medical benefits through the extensive INTEGRIS Health network
Financial assistance for continued education
24/7 mental health support