.. screenings and assessments based on a review of available records and clinical interviews with inmates. * Provides treatment to inmates by developing, implementing and modifying individual treatment plans based on an evaluation of needs and level of functioning. * Documents treatment and evaluation activities .. read more
Saint Francis Health System is seeking a Registered Nurse (RN) Manager for a nursing job in Tulsa, Oklahoma.
Job Description & Requirements- Specialty: Manager
- Discipline: RN
- Start Date: ASAP
- Duration: Ongoing
- Employment Type: Staff
Current Saint Francis Employees - Please click HERE to login and apply.
Full Time
11p - 7a
Hours: Monday - Friday | 11:00pm - 7:00a
Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of patients including, but not limited to their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to the improvement of internal processes.
Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Nursing.
Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License.
Work Experience: Minimum 3 years of related experience in an acute care setting.
Knowledge, Skills and Abilities: Ability to organize and prioritize work in an effective and efficient manner. Effective interpersonal, written, and oral communication skills. Demonstrated ability to integrate the analysis of data to discover facts or develop knowledge, concepts, or interpretations. Ability to be detail oriented as required in the examination of numerical data. Ability to synthesize clinical case data into concise summaries. Working knowledge of Microsoft Word, Excel and Access in the preparation of correspondence and reports.
Essential Functions and Responsibilities: Gathers, prepares and supplies required clinical/treatment information needed to obtain authorization within the review interval(s) time requirements. Participates in treatment team and/or Patient Care Committee by providing information about eligibility, benefits, and criteria for the selected level of care. Assists in discharge planning, as needed. Identifies QI Triggers for individual patient situations, reporting them promptly to the UM Manager, appropriate clinicians and Process Improvement/Quality Director. Reviews eligibility and benefits of patients to validate accurate level of care utilization. Investigates and prepares appeals for insurance companies when denial of reimbursement is related to medical necessity or to other treatment issues. Participates in quality-of-care and UM process improvement on an ongoing basis and assists with development of the UR Staff Committee's process improvement goals. Provides staff education to further the goals of UR.
Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.
Special Job Dimensions: None.
Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Utilization Review Management - Yale Campus
Location:
Tulsa, Oklahoma 74136
EOE Protected Veterans/Disability
Saint Francis Healthcare System Tulsa Job ID #JR14041. Posted job title: Utilization Management Nurse (Rn) | M - F | 11P - 7A
About Saint Francis Health SystemSaint Francis Health System is a Catholic, not-for-profit health system wholly owned and operated in Tulsa, Oklahoma whose mission is to extend the presence and healing ministry of Christ to all who seek its services. The health system is anchored by Saint Francis Hospital, a 1,112-bed tertiary center, which includes the region's only children's hospital and level IV neonatal intensive care unit, a 168-bed heart hospital and Tulsa's leading trauma and emergency center. Additionally, Saint Francis employs more than 450 providers through Warren Clinic, which serves the region with more than 95 locations throughout eastern Oklahoma. In total, the organization has more than 11,500 employees, 1,000 physicians and 700 volunteers, making it the largest private employer in Tulsa County.
Benefits- Holiday Pay
- Continuing Education
- 401k retirement plan
- Wellness and fitness programs
- Employee assistance programs
- Medical benefits
- Vision benefits
- Dental benefits