Utilization Management Nurse

Do you have a passion for helping patients receive the best possible care while also optimizing resources? Are you a registered nurse with experience in utilization management? If so, Saint Francis Health System is looking for a Utilization Management Nurse to join our dynamic team. As a Utilization Management Nurse, you will play a crucial role in ensuring the appropriate utilization of healthcare resources for our patients. We are seeking a knowledgeable and compassionate individual who is dedicated to providing high-quality care and has strong communication and critical thinking skills. If this sounds like you, we encourage you to apply and be a part of our mission to provide exceptional care to our community.

1. Conduct Utilization Management Reviews: Conduct timely and thorough reviews of medical records to assess the appropriateness and necessity of healthcare services and resources being utilized for patients.
2. Collaborate with Healthcare Team: Work closely with physicians, nurses, and other healthcare professionals to determine the most effective and efficient care plan for patients while optimizing the use of resources.
3. Educate Patients and Families: Educate patients and their families on the appropriate use of healthcare resources and provide guidance on resources available to them.
4. Maintain Documentation: Accurately document all utilization management activities and communication with patients, families, and healthcare team members in a timely and organized manner.
5. Utilize Evidence-Based Practices: Stay up to date on evidence-based practices and guidelines for utilization management to ensure the best possible care for patients.
6. Analyze Data: Utilize data analysis and critical thinking skills to identify patterns and trends in resource utilization, and make recommendations for improvement.
7. Communicate with Insurance Companies: Communicate with insurance companies and other third-party payers to ensure proper coverage and reimbursement for services provided to patients.
8. Monitor and Report Utilization Trends: Monitor and report on utilization trends, potential risk areas, and opportunities for improvement to management and other relevant parties.
9. Provide Support and Training: Provide support and training to healthcare team members on utilization management principles and processes to ensure compliance and understanding.
10. Uphold Professional Standards: Adhere to all ethical and professional standards for nursing practice, including maintaining patient confidentiality and promoting patient advocacy.
11. Support Organizational Mission: Contribute to the overall mission and goals of the organization by providing high-quality, cost-effective care to patients and promoting the efficient use of healthcare resources.

According to JobzMall, the average salary range for a Utilization Management Nurse in Tulsa, OK, USA is $67,000 - $85,000 per year. This can vary depending on factors such as years of experience, education level, and specific employer.

Saint Francis Health System is an integrated health system in Tulsa, Oklahoma, with an emphasis on a complete continuum of care. With more than 10,000 employees, 1,000 physicians and 90 locations, Saint Francis Health System provides the community's largest network of healthcare services.