Top 57 Utilization review/case Jobs in Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
IOM Technologist-Cincinnati, OH
MPOWERHealth —Ohio
- On call
- CPR Certification
- Anatomy knowledge
- Surgery
- Paid training
- Health savings account
Quick Apply
UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
- $24 - $32 an hour
- Full-time
- Nursing
- Adults
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
Appeals and Grievances Specialist
Sidecar Health —Columbus, OH
- $65,000 - $75,000 a year
- Remote
- Mid-level
- 3 years
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
4d
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
Network Operational Resident Engineer
Hewlett Packard Enterprise —Columbus, OH
- $92,600 - $213,500 a year
- Full-time
- 5 years
- Mid-level
- Office
Clinician (Counselor) - Franklinton
Basecamp Recovery Center —Columbus, OH
- $26 - $38 an hour
- Weekends as needed
- LMFT
- Spanish
- CPR Certification
- Paid holidays
- Loan repayment program
Quick Apply
Sr Supply Chain Coordinator
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Pass drug screening
- Mid-level
- Paid parental leave
- Disability insurance
12d
Housing Director
BASECAMP RECOVERY LLC —Columbus, OH
- $60,000 - $70,000 a year
- Weekends as needed
- Clean driving record
- Addiction Medicine
- Pass drug screening
- Health insurance
- Dental insurance
Quick Apply
Care Manager - Inpatient - Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
5d
Case Manager - Housing
Springway Medical —Columbus, OH
- $15 - $18 an hour
- Full-time
- Background check
- Addiction Medicine
- HIPAA
Quick Apply
13d
Healthcare Program Manager
Care Of Excellent Llc —Columbus, OH
- $50,000 - $90,000 a year
- Weekends as needed
- Nursing
- Ability to walk for extended periods
- 5 years
- 401(k)
- Opportunities for advancement
Quick Apply
Production Control Specialist / Production Operations Associate III
FIS Global —Columbus, OH
- Full-time
- Pass drug screening
- Data analysis skills
- Mid-level
9d
Advisor, IT Admin & Strategy Execution
OhioHealth —Columbus, OH
- Full-time
- 7 years
- Finance
- Analysis skills
Clinician - Franklinton
BASECAMP RECOVERY LLC —Columbus, OH
- $24 an hour
- Weekends as needed
- LMFT
- Spanish
- CPR Certification
- Paid holidays
- Health insurance
Quick Apply
14d
Discharge Planner
SUN Behavioral Columbus —Columbus, OH
- Full-time
- CPR Certification
- LVN
- Writing skills
Quick Apply
7d
Counselor
Pinnacle Treatment Centers —Columbus, OH
- Full-time
- LMFT
- Mid-level
- High school diploma or GED
- Continuing education credits
- Paid holidays
Quick Apply
22h
Clinical Supervisor
RESOLVE WELLNESS LLC —Columbus, OH
- $30 - $35 an hour
- Full-time
- Outpatient experience
- 3 years
- Master's degree
- Paid holidays
- Paid time off
Quick Apply
Manager, Delivery - CX AI
TELUS Digital —Columbus, OH
- $100,000 - $160,000 a year
- Full-time
- Hybrid work
- 7 years
- Office
- Continuous improvement
County Supervisor
Integrated Services for Behavioral Health —Circleville, OH
- $48,596.66 - $79,175.95 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Quick Apply

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utilization review/case jobs near columbus

Utilization Review Specialist - Autism

Nationwide Children's Hospital -
Columbus, OH

Apply Now

Job Details

Full-time

Benefits

Work from home

Qualifications

Bachelor's degree
Pediatrics
Working with individuals with mental health conditions

Full Job Description

Overview:

Schedule: Monday-Friday (8:00am-4:30pm)

Position is work from home after a 90 day in-office training period.

Job Description Summary:

Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.

Job Description:

Essential Functions:

Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
Provides education and support regarding utilization review and management activities and processes.
Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.

Education Requirement:

Bachelor’s Degree in Social Work, Psychology, or related field, required.

Licensure Requirement:

(not specified)

Certifications:

(not specified)

Skills:

Excellent written and verbal communication and interpersonal skills.
Excellent customer service and organizational skills.
Working knowledge of CMS and other review agency standards.
Proficient with software applications including CM, payer web applications, MITS, and others.

Experience:

Three years of behavioral health experience, required.
One year of experience in pediatric care or services, required.
Utilization review or utilization management experience, preferred.

Physical Requirements:

OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel

FREQUENTLY: Standing, Walking

CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting

Additional Physical Requirements performed but not listed above:

(not specified)

"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"

Apply Now

Refine Your Search

utilization review/case jobs in columbus

Utilization Review Specialist - Autism

IOM Technologist-Cincinnati, OH

UR Coordinator, Full Time

Appeals and Grievances Specialist

OhioRISE CME Care Coordinator Supervisor I

Network Operational Resident Engineer

Clinician (Counselor) - Franklinton

Sr Supply Chain Coordinator

Housing Director

Care Manager - Inpatient - Oncology

Case Manager - Housing

Healthcare Program Manager

Production Control Specialist / Production Operations Associate III

Advisor, IT Admin & Strategy Execution

Clinician - Franklinton

Discharge Planner

Counselor

Clinical Supervisor

Manager, Delivery - CX AI

County Supervisor

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