JOB SUMMARY

The Prior Authorization/Utilization Review Nurse is responsible for carefully recording information regarding patient care on the back end of the clinic and doctor's office visits in hopes of keeping healthcare costs low for both patients and the organization.

ESSENTIAL JOB FUNCTIONS

• Ensure the highest quality of patient care through systematic reviews of the patient's medical records and active communication with the patient, family members, and healthcare teams.
• Reviews and makes decisions about the appropriateness and level of patient care being provided.
• Ensures patients receive necessary care without performing unnecessary or duplicate services.
• Must have understanding of most common disease processes and associated medications.
• Ability to extract relevant clinical information to satisfy payer source requirements for reimbursement.
• Must be able to track and follow-up on multiple cases at a time.
• Work closely with pharmacy, providers, and accounts receivable to close the loop on unpaid pharmacy claims.
• Ensure accurate and timely documentation of calls and to return calls in a timely manner.
• Each recommendation must be evaluated carefully to ensure that every patient receives the care they need. Case determinations should include clear evidence to support the recommendation.
• Other duties as assigned.

REQUIRED LICENSE, CERTFICIATION, EDUCATION, SPECIALIZED SKILLS

• High School diploma or equivalent.
• Completion of an accredited RN program. Current and valid Oklahoma RN license.
• 3 years of clinical experience preferred.
• BLS CPR Certification.
• Intermediate computer skills.
• Strong communication skills.

WORKING CONDITIONS

MEDICAL: This position involves sitting and may view the computer screen for long periods of time. Must be able to prioritize activities when faced with competing demands. This position requires mental and physical demands. Intermittent physical activity including walking, standing, sitting, lifting and supporting patients is essential. This position performs tasks that involve exposure to patients as well as blood, body fluids, or tissues. Incumbent will be exposed to virus, disease and infection from patients and specimens in working environment. Personal protective equipment use required.

Job Type: Full-time

Pay: $65,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Weekly day range:

• Monday to Friday
• No weekends

Ability to Relocate:

• Tulsa, OK 74120: Relocate before starting work (Required)

Work Location: In person