RN Case Manager – Utilization Review

INTEGRIS Health

Part-time RN case manager reviewing utilization and coordinating discharge planning. Supporting patients and clinicians within Oklahoma’s largest nonprofit health system.

Posted 8/14/2026part-timeRemote • Oklahoma • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in patient assessment, discharge planning, and resource utilization while maintaining compliance with CMS and payer regulations. Strong ability to collaborate with healthcare teams and educate patients and families on care management processes.

Highest-signal resume keywords

RN Licensure in Oklahoma or eNLC Member StateCase Management CertificationExperience in Clinical SettingKnowledge of CMS and Payer RegulationsBLS Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Patient AssessmentDischarge PlanningResource UtilizationUtilization ReviewData Collection for Quality Improvement

Soft Skills

Interpersonal CommunicationCollaboration Skills

Tools & Technologies

Computer Experience

Certifications & Qualifications

BLS CertificationCase Management Certification

Industry Keywords

Managed CarePayer/Provider RequirementsCMS RegulationsMedicare/MedicaidHealthcare Organizations

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 to healthcare and community organizations
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 timely discharge
Conduct concurrent reviews of patient records
Apply utilization criteria to determine appropriate resource utilization
Notify internal and external contacts about utilization issues affecting patient care or reimbursement
Facilitate patient transfers to other healthcare organizations according to policies and applicable regulations
Advise physicians on discharge planning, medical-record documentation, resource utilization, and reimbursement issues
Maintain knowledge of CMS, Medicare/Medicaid, managed-care, payer regulations, and benefit limits
Educate patients, families, and healthcare professionals about payer regulations
Develop knowledge of hospital and community resources and facilitate appropriate levels of care
Identify opportunities to reduce care-management costs without affecting quality or outcomes
Collect and record data for utilization and Quality Improvement reporting
Work collaboratively with patients, families, physicians, hospital staff, and external agencies

Requirements

What you’ll need

2 years of experience in a clinical setting, such as home health, inpatient, physician office, or clinic
Current RN licensure in Oklahoma or a current multistate license from an eNLC member state
BLS certification issued by the American Red Cross or American Heart Association within 30 days of hire
Excellent interpersonal communication and collaboration skills
Computer experience
Experience with managed care and payer/provider requirements
Bachelor of Science in Nursing
Case Management Certification

Benefits

Comp & perks

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