RN Utilization Management (UM) Reviewer
APS Healthcare - Oklahoma City, OK

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At APS Healthcare, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission is quite simply to improve the health of those we serve.

APS is seeking a RN UM Reviewer to join this exciting program in our Oklahoma City office. The UM RN provides telephonic utilization review for providers and facilities requesting clinical services.

Essential Functions:
  • Provides telephonic utilization Management, education and other clinically based activities to plan members.
  • Collects clinical data and enters information into database for tracking and metrics purposes.
  • Monitors and evaluates the services and community based resources necessary to respond to the individual member’s health needs.
  • Completes other special assignments and projects as assigned
Education:
  • Associate’s degree in Nursing or Diploma in Nursing required.
  • Must have a valid and unrestricted RN license in the state of Oklahoma.
Qualifications:
  • Minimum 3 years clinical experience.
  • Previous experience in utilization review, quality assurance, disease management or case management preferred.
  • Knowledge of chronic illness, co-morbidities, and general disease states.
  • Strong clinical assessment skills, consistent with state licensure scope of practice requirements.
  • Excellent written & verbal communication skills.
  • Strong telephonic interviewing skills.
  • Proficient in Microsoft Office and Internet/Web Navigation.
  • Excellent prioritization and organizational skills.
  • Ability to assess patient health status, consistent with state licensure scope of practice requirements.
  • Ability to integrate data and evaluate to design meaningful interventions.
  • Must be able to prioritize and target interventions, consistent with state licensure scope of practice requirements.

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