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

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company This role involves collaborating with health care providers to ensure patients receive appropriate care while adhering to reputed company 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 reputed company tools. • Coordinates with the interdisciplinary reputed company team, Payors, patients, and families to ensure appropriate status and financial reimbursement. • Provides education to patients and their families regarding their reputed company stay and appropriate status in compliance with mandated regulatory and financial expectations. • Coordinates and facilitates communication between patients, families, reputed company providers, and Payor sources to optimize appropriate patient and reputed company system financial reimbursement reputed company. • Evaluates patient clinical information, utilizes Evidence based reputed company tool, and collaborates with Payors as required. • Evaluates reputed company utilization patterns and identifies opportunities for improving efficiency and cost-effectiveness based on Payor reputed company and reputed company Mandated regulatory guidelines. • Advocates for appropriate status to meet patient and system needs while adhering to regulatory guidelines and reimbursement reputed company. • Collaborates with insurance providers, Interdisciplinary teams, and other stakeholders to ensure reputed company authorization of services and coverage for patient hospital care and treatment. • Monitors and evaluates patient and reputed company system financial reputed company and processes to identify areas for improvement. • Participates in reputed company 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 reputed company as accreditation requirements reputed company 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 reputed company secure Internet and Cellular phone services. • Maintains continuing Education with approved Evidence based reputed company tool and Departmental Process Competencies and participates in reputed company Audit review findings. Qualifications • Level I: Associate's Degree in Nursing required. • reputed company: 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. • reputed company: At least 3 years of Care Management experience required. • Level III: 5 or more years of Care Management experience required. • reputed company Registered reputed company License (RN License issued by the Oklahoma State reputed company of Nursing, or a reputed company multistate compact Registered reputed company (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. Apply tot his job Apply To this Job