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Registered Nurse Reviewer

Details

Country: USA
Location: Oklahoma City OK
Total applied: 40
Location:US-OK-Oklahoma City

Base Pay:N/A

Commission:
$0.00Employee Type:Full-Time Employee

Industry:Healthcare - Health Services

Manages Others:no

Registered Nurse Reviewer

*The RN Reviewer is responsible for coordinating the prior authorization process, admissions medical necessity determinations, prospective reviews, concurrent reviews, retrospective reviews, and overall quality of care.
*Assesses appropriateness of care delivered in accordance with established guidelines promulgated by the OHCA and APS
*Authorizes proposed treatment plans, coordinates care, assesses member safety needs and consults with physicians as needed
*Communicates with providers in the community regarding pending services and assists in monitoring / facilitating care plans for specialized needs of recipients
*Attends clinical meetings as needed
*Identifies and documents quality management indicators
REQUIREMENTS
Registered Nurse; Master's Degree in Nursing
Valid, unrestricted license in state of Oklahoma

Four (4) years clinical experience in related public sector behavioral health care including experience with quality improvement and medical record reviews, at least two (2) years clinical experience in psychiatric setting

Experience in outpatient clinical settings, and/or residential care, preferred

Experience and background in various community mental health populations

Experience in utilization management and review

Computer knowledge required

Strong verbal and written communication skills

Customer service focus

Ability to resolve problems in non-threatening manner

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