[Hiring] Utilization Review Nurse - Registered Nurse (Levels 1-3) - Children's Behavioral Health Center (Fall 2026) @OU Health

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Role Description

This role involves collaborating with health care providers to ensure patients receive appropriate care while adhering to healthcare regulations. This work is performed through evaluation of medical necessity, collaboration with insurance companies, patients, patient families, and providers, and securing payor authorization for hospital stays.
• Conducts comprehensive assessments of patients' health status, medical history, and ongoing care needs utilizing evidence-based criteria tools.
• Coordinates with the interdisciplinary healthcare team, Payors, patients, and families to ensure appropriate status and financial reimbursement.
• Provides education to patients and their families regarding their healthcare stay and appropriate status in compliance with mandated regulatory and financial expectations.
• Coordinates and facilitates communication between patients, families, healthcare providers, and Payor sources to optimize appropriate patient and healthcare system financial reimbursement outcomes.
• Evaluates patient clinical information, utilizes Evidence based criteria tool, and collaborates with Payors as required.
• Evaluates healthcare utilization patterns and identifies opportunities for improving efficiency and cost-effectiveness based on Payor contracts and Healthcare Mandated regulatory guidelines.
• Advocates for appropriate status to meet patient and system needs while adhering to regulatory guidelines and reimbursement criteria.
• Collaborates with insurance providers, Interdisciplinary teams, and other stakeholders to ensure timely authorization of services and coverage for patient hospital care and treatment.
• Monitors and evaluates patient and healthcare system financial outcomes and processes to identify areas for improvement.
• Participates in quality improvement initiatives and interdisciplinary care conferences to promote evidence-based practices and enhance patient safety and satisfaction.
• Ensures compliance with federal, state, and local regulations, as well as accreditation requirements related to Nursing care management and patient continuum of care.
• Implements approved strategies to minimize readmissions, prevent financial complications, and optimize appropriate financial reimbursement processes.
• Maintains a HIPPA compliant work environment to protect Patient Protected Health Information while working from home. Must provide secure Internet and Cellular phone services.
• Maintains continuing Education with approved Evidence based criteria tool and Departmental Process Competencies and participates in Quality Audit review findings.

Qualifications
• Level I: Associate's Degree in Nursing required.
• Level II: Bachelor's Degree in Nursing required.
• Level III: Bachelor's Degree in Nursing required.

Requirements
• Level I: 0-3 years of RN experience required, experience in Care Management preferred.
• Level II: At least 3 years of Care Management experience required.
• Level III: 5 or more years of Care Management experience required.
• Current Registered Nurse License (RN License issued by the Oklahoma State Board of Nursing, or a current multistate compact Registered Nurse (eNLC)).

Benefits
• Comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more.
• Competitive total rewards package including up to a $10,000 sign-on bonus.

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