Top 12 Utilization specialist hybrid Jobs in Columbus

Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
- Weekends as needed
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid time off
- 401(k) matching
Quick Apply
5d
Auto Damage Claims Specialist
Central Insurance Company —Dublin, OH
- Full-time
- Hybrid work
- Mid-level
- Travel
- Conflict management
- Health insurance
12d
Contracts Specialist
Battelle —Columbus, OH
- $55,400 - $77,600 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Wellness program
- Health insurance
11d
Cryo Nerve Block Clinical Specialist-Columbus
AtriCure —Columbus, OH
- $70,000 - $125,000 a year
- Remote
- Mid-level
- Bachelor's degree
- Operating room
- Paid parental leave
- Health savings account
Electrical Engineer - Medical Device Solutions
Battelle —Columbus, OH
- Full-time
- Hybrid work
- Mid-level
- Office
- Travel
- Wellness program
- Health insurance
Instructional Technology Analyst – XR and Emerging Technologies
The Ohio State University —Columbus, OH
- $58,700 - $77,200 a year
- Extended hours
- Background check
- Nursing
- Pass drug screening
Instructional Technology Analyst – Simulation Technology
The Ohio State University —Columbus, OH
- $58,700 - $77,200 a year
- Extended hours
- Background check
- Nursing
- Pass drug screening
Product Specialist II
T-Cetra LLC —Dublin, OH
- $65,000 - $75,000 a year
- Full-time
- Hybrid work
- Background check
- Marketing
- Pass drug screening
- Wellness program
- Health insurance
Quick Apply
Program Manager, Rapid Mission Technologies
Battelle —Columbus, OH
- Full-time
- Hybrid work
- Computer Science
- Office
- Travel
- Wellness program
- Health insurance
Organ Recovery Specialist - NIGHT SHIFT
Lifeline of Ohio —Columbus, OH
- Full-time
- Hybrid work
- Surgery
- Mid-level
- Office
- Paid parental leave
- Health savings account
Quick Apply
Director of Engineering, Energy Storage
SOLV Energy, LLC —Columbus, OH
- $170,074 - $226,199 a year
- Full-time
- Up to 50% travel
- 5 years
- Travel
- Paid holidays
- Disability insurance
Quick Apply
Complex Care Manager RN-Western MA (Hybrid)
WellSense Health Plan —United States
- $74,000 - $107,000 a year
- Full-time
- Hybrid work
- Background check
- School experience
- Nursing
- Health insurance
- Dental insurance

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Large Loss Bodily Injury Adjuster
National General —Columbus, OH
Candidates should be skilled in evaluating complex losses, assessing risk and exposure, and driving claims through to successful resolution.
$98,100 - $167,850 a year
2d
Auto Damage Claims Specialist
Central Insurance Company —Dublin, OH
Ability to obtain and maintain all required state department of insurance adjusting licenses and CE’s within 90 days of employment. AINS or AIC designation(s).
12d

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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply
5d
Auto Damage Claims Specialist
Central Insurance Company —Dublin, OH
Ability to obtain and maintain all required state department of insurance adjusting licenses and CE’s within 90 days of employment. AINS or AIC designation(s).
12d

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utilization specialist hybrid jobs near columbus

Utilization Management Specialist

ST VINCENT FAMILY SERVICES
Columbus, OH

Quick Apply

Job Details

Full-time
5 days ago

Benefits

Paid time off
401(k) matching

Qualifications

Associate's degree

Full Job Description

At St. Vincent Family Services, it's our job to help families build bright futures. Make it your job, too!

We offer competitive compensation based on education, experience, licensure, and internal equity, along with comprehensive benefits, 401(k) matching, and a generous PTO package.

These are just a few of the many reasons to join our team.

SUMMARY

The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs). This position serves as the primary liaison between St. Vincent Family Services and MCO payors to ensure authorization requests are submitted timely, approved services are tracked accurately, and service disruptions are prevented.

The Utilization Management Specialist monitors client eligibility, tracks authorized units by procedure code, manages authorization renewals, and communicates authorization approvals and denials to treatment teams. This role works closely with clinical staff, program leadership, billing, and MCO representatives to maximize reimbursement, ensure compliance with payer requirements, and support continuity of care for clients.

ESSENTIAL DUTIES & RESPONSIBILITIES

Maintains confidentiality and compliance with HIPAA, agency policies, and payer regulations.
Serves as the primary point of contact for all MCO prior authorization activities.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals, denials, and requests for additional information.
Verifies and documents client eligibility and insurance coverage prior to authorization submission and throughout treatment episodes.
Runs authorization utilization reports and analyzes data to identify clients approaching authorization thresholds.
Maintains an authorization tracking system that includes:
- Authorization numbers
- Approved dates of service
- Procedure codes
- Authorized units
- Units utilized
- Remaining units
- Expiration dates
Monitors service utilization and proactively identify clients nearing authorized unit limits.
Requests completed clinical documentation and authorization forms from treatment providers when renewal thresholds are met.
Reviews authorization packets for completeness and accuracy prior to MCO submission.
Submits initial, concurrent, and reauthorization requests to Medicaid Managed Care Organizations within required timelines.
Coordinates responses to MCO requests for additional documentation or clinical information.
Communicates authorization approvals, denials, partial approvals, and service changes to treatment team members in a timely manner.
Collaborates with program directors, treatment providers, and billing staff to resolve authorization concerns and prevent service interruptions.
Maintains organized electronic records of all authorization submissions, determinations, and correspondence.
Tracks authorization denial patterns and communicates trends to leadership.
Assists with audits, quality assurance activities, and compliance reviews related to authorization management.
Develops and maintains productive working relationships with MCO representatives.
Participates in department meetings, training, and process improvement initiatives.
Performs other duties as assigned.

QUALIFICATIONS

Education and/or Experience:

Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Minimum of two years of experience in healthcare authorization management, utilization management, medical billing, behavioral health administration, or related healthcare setting preferred.

Knowledge, Skills & Abilities:

Strong understanding of behavioral health authorization processes and payer requirements.
Knowledge of Medicaid and Managed Care authorization procedures preferred.
Excellent organizational skills and attention to detail.
Strong analytical skills and ability to interpret utilization and authorization reports.
Ability to manage multiple deadlines and competing priorities.
Ability to communicate effectively with clinical, administrative, and payer representatives.
Ability to maintain accurate records and follow complex payer requirements.
Ability to work independently while functioning as part of a collaborative team.

Technical Skills

Proficiency in Microsoft Outlook, Excel, Word, and Teams.
Ability to learn and navigate multiple MCO portals.
Experience with electronic health records and data management systems.
Ability to generate, analyze, and maintain utilization tracking reports.

WORK ENVIRONMENT

Standard office environment with occasional evenings/weekends for events. Hybrid schedule available after 90-day probationary period.

Requires prolonged sitting and extensive computer use.
Requires manual dexterity sufficient to operate a computer, telephone, and other office equipment.
Requires normal range of hearing and vision to prepare reports and communicate effectively.
May occasionally lift and/or move items up to 15 pounds.

Quick Apply

Refine Your Search

utilization specialist hybrid jobs in columbus

Utilization Management Specialist

Auto Damage Claims Specialist

Contracts Specialist

Cryo Nerve Block Clinical Specialist-Columbus

Electrical Engineer - Medical Device Solutions

Instructional Technology Analyst – XR and Emerging Technologies

Instructional Technology Analyst – Simulation Technology

Product Specialist II

Program Manager, Rapid Mission Technologies

Organ Recovery Specialist - NIGHT SHIFT

Director of Engineering, Energy Storage

Complex Care Manager RN-Western MA (Hybrid)

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