RN Case Manager – Utilization Review

INTEGRIS Health

RN Case Manager conducting utilization review and discharge planning at INTEGRIS Health, Oklahoma’s largest nonprofit health system. Coordinating patient care, transfers, payer compliance, and resource utilization.

Posted 8/10/2026full-timeOklahoma City • Oklahoma • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in patient assessment, discharge planning, and resource utilization while ensuring compliance with CMS, Medicare, and Medicaid regulations. Strong ability to communicate effectively with patients, families, and healthcare professionals to facilitate timely and efficient care transitions.

Highest-signal resume keywords

Patient AssessmentDischarge PlanningResource UtilizationBLS CertificationRegistered Nurse Licensure

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical AssessmentDischarge PlanningUtilization ReviewData CollectionQuality Improvement Reporting

Soft Skills

Interpersonal CommunicationCollaborationEffective Verbal CommunicationWritten Communication

Tools & Technologies

Computer Experience

Certifications & Qualifications

BLS CertificationCase Management Certification

Industry Keywords

CMS RegulationsMedicareMedicaidManaged CarePayer Regulations

About the role

Key responsibilities & impact

Complete comprehensive assessments of patients’ clinical, psychological, and financial needs
Recommend and coordinate timely transfers to appropriate levels of care
Develop, implement, evaluate, and revise discharge plans, including referrals
Communicate discharge care plans and changes to patients, families, and healthcare professionals
Assist physicians and hospital staff with resource utilization and timely discharge planning
Coordinate services between hospital departments to facilitate patient discharge
Conduct concurrent reviews of patient records
Apply utilization criteria to determine appropriate resource utilization
Notify internal and external contacts of utilization issues affecting patient care or reimbursement
Facilitate patient transfers in accordance with hospital policies and state and federal guidelines
Advise physicians on discharge planning, documentation, resource utilization, and reimbursement
Manage established care pathways to enhance clinical effectiveness and resource management
Maintain knowledge of CMS, Medicare, Medicaid, managed care, payer regulations, and benefit limits
Educate patients, families, and healthcare professionals regarding payer regulations
Identify appropriate hospital and community resources and levels of care
Identify cost-reduction opportunities without compromising quality or outcomes
Collect and record data for utilization and Quality Improvement reporting
Collaborate with patients, families, physicians, hospital staff, and care agencies

Requirements

What you’ll need

2 years of experience in a clinical setting, such as home health, inpatient, physician office, or clinic
Current BLS certification issued by the American Red Cross or American Heart Association within 30 days of hire
Current Registered Nurse licensure in Oklahoma or a current multistate license from an eNLC member state
Excellent interpersonal communication and collaboration skills
Computer experience
Effective verbal and written communication in English
Current Oklahoma State Driver’s License
Driving record acceptable to the employer’s insurance carrier
Experience with managed care and payer/provider requirements preferred
Bachelor of Science in Nursing preferred
Case Management Certification preferred

Benefits

Comp & perks

Front-loaded PTO
Medical benefits through the extensive INTEGRIS Health network
Financial assistance for continued education
24/7 mental health support
Career and development opportunities