Top 51 Utilization review Jobs in Columbus

Specialist, Utilization Review
Columbus Springs East —Columbus, OH
- Full-time
- CPR Certification
- Management
- BLS Certification
- Disability insurance
- Health insurance
Quick Apply
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
2d
Medical Office Administrator
OHG —Columbus, OH
- $35 - $50 an hour
- Full-time
- Nursing
- Administrative experience
- Clinic
- Health insurance
- Dental insurance
Quick Apply
Outpatient Navigator
Mount Carmel Behavioral Health —Columbus, OH
- Full-time
- LMFT
- Psychiatry
- Hospital
9d
UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
- $24 - $32 an hour
- Full-time
- Nursing
- Adults
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
Homecare Prior Authorization Supervisor
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
Client Insurance Specialist
Integrated Services for Behavioral Health —Columbus, OH
- $20.97 - $24.56 an hour
- Hybrid work
- Mid-level
- Organizational skills
- 2 years
- Disability insurance
- Health insurance
Quick Apply
Patient Support Nurse
Valeris, Inc. —Columbus, OH
- Full-time
- Background check
- RN License
- Pass drug screening
- Health savings account
- AD&D insurance
Quick Apply
6h
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
- $40.40 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
2d
Community Behavioral Health Worker
Integrated Services for Behavioral Health —Columbus, OH
- $19.00 - $22.26 an hour
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Quick Apply
4d
Dental Office Manager
Norton Family Dental —Columbus, OH
- From $26 an hour
- Full-time
- Nursing
- Dental office
- BLS Certification
- Health savings account
- Health insurance
Quick Apply
Nurse Practitioner
Buckeye Clinic —Columbus, OH
- $110,550.81 - $133,136.47 a year
- Part-time
- Medication administration
- HIPAA
- Mid-level
- Paid time off
- Flexible schedule
Quick Apply
Nurse - Skilled/Purchased Care Coordinator
US Veterans Health Administration —Columbus, OH
- $70,726 - $148,921 a year
- Online Application
- Hybrid work
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
7d
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
OhioRISE Navigator- Inpatient & Community Transitions
I Am Boundless, Inc. —Delaware, OH
- $49,895 - $60,114 a year
- Full-time
- Background check
- Nursing
- Pass drug screening
- Paid holidays
- Disability insurance
Quick Apply
RN - Case Manager
Vibra Travels LLC —Dublin, OH
- $2,157 a week
- Online Application
- Nursing
- RN License
- BLS Certification
- Referral program
Quick Apply
1d
Staff Pharmacist- Closed Door, Hybrid-2nd Shift, 4-10 hour shifts
Kroger Health & Wellness —Columbus, OH
- 4 hour shift
- Management
- HIPAA
- Mid-level
Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
OhioRISE CME Care Coordinator Supervisor I
THE VILLAGE NETWORK —Columbus, OH
- Full-time
- Experience working with individuals with developmental disabilities
- Computer literacy
- HIPAA
- Paid holidays
- Paid time off
Intake LPN Home Health and Hospice
SHC WVUHS Home Care —Columbus, OH
- Full-time
- Nursing
- Mid-level
- Home Health
6d

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Specialist, Utilization Review

Columbus Springs East -
Columbus, OH

Quick Apply

Job Details

Full-time

Benefits

Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Loan assistance

Qualifications

Bachelor's degree

Full Job Description

Your experience matters

At Columbus Springs-East, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts
Competitive paid time off and extended illness bank package for full-time employees
Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
Tuition reimbursement, loan assistance, and 401(k) matching
Employee assistance program including mental, physical, and financial wellness
Professional development and growth opportunities

How you’ll contribute
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.

Qualifications and requirements

Education: Bachelor’s degree required. Master’s degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred

Essential Functions:

Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed service.
Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
Works with DON to ensure documentation requirements are met.
Ensure appeals are completed thoroughly and on a timely basis.
Interface with managed care organizations, external reviews, and other payers.
Communicate with physicians to schedule peer to peer reviews.
Accurately report denials.

SUPERVISORY RESPONSIBILITIES:
Manage the work of others, including planning, assigning, scheduling and reviewing work, ensures quality standards. Responsible for hiring, terminating, training and developing, reviewing performance and administering corrective action for staff.

About Us
Columbus Springs - East is a 72 bed hospital located in Columbus, OH, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone—your experience matters

EEOC Statement

Columbus Springs – East is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.

We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

Quick Apply

Refine Your Search

utilization review jobs in columbus

Specialist, Utilization Review

Utilization Review Specialist - Autism

Medical Office Administrator

Outpatient Navigator

UR Coordinator, Full Time

Homecare Prior Authorization Supervisor

Client Insurance Specialist

Patient Support Nurse

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

Community Behavioral Health Worker

Dental Office Manager

Nurse Practitioner

Nurse - Skilled/Purchased Care Coordinator

Denials RN Coordinator

OhioRISE Navigator- Inpatient & Community Transitions

RN - Case Manager

Staff Pharmacist- Closed Door, Hybrid-2nd Shift, 4-10 hour shifts

Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)

OhioRISE CME Care Coordinator Supervisor I

Intake LPN Home Health and Hospice

I want to receive the latest job alert for utilization review in columbus

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