Top 16 Utilization review nurse Jobs in Dayton Oh

Registered Nurse - Utilization Manager
Decypher —Wright-Patterson AFB, OH
- $44.92 an hour
- 8 hour shift
- Bachelor of Science
- Mid-level
- Ability to sit for extended periods
Quick Apply
RN Utilization Rvw Spclst - Utilization Management
Kettering Health —Miamisburg, OH
- Part-time
- Nursing
- RN License
- 5 years
CSI ANALYST/SYSTEM SUPPORT-MVH/FT
System Support —Dayton, OH
- Full-time
- Microsoft Word
- Nursing
- RN License
Utilization Review Coordinator
Neuropsychiatric Hospitals —Huber Heights, OH
- Full-time
- Nursing
- Psychiatry
- Mid-level
- Health insurance
- Dental insurance
CASE MANAGER
Miami Valley Hospital —Dayton, OH
- Full-time
- Nursing
- RN License
- Hospital
Case Manager - PRN Days | Miamisburg Rehab
PAM Health, LLC —Miamisburg, OH
- PRN
- RN License
- Hospital
- BLS Certification
- Opportunities for advancement
- Referral program
Quick Apply
CASE MANAGER / REGISTERED NURSE / RN
Upper Valley Medical Center —Troy, OH
- Nursing
- RN License
- Hospital
5d
Admissions & Medical Records Nurse (LPN, RN)
Cypress Pointe Health Campus —Englewood, OH
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Health savings account
MDS Nurse Transition Leader
Otterbein SeniorLife —Springboro, OH
- Nursing
- RN License
- 5 years
- Paid holidays
- Dental insurance
Quick Apply
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

Discover related jobs

Based on your search for utilization review nurse jobs.

DRG Coding Auditor Principal
Elevance Health —Mason, OH
Requires at least one of the following certification: RHIA certification as a Registered Health Information Administrator, RHIT certification as a Registered…
$122,240 - $183,360 a year
4d
HIMS ROI Specialist II - HIMS Release Information
Kettering Health —Miamisburg, OH
Associate degree in health information management or health-related field preferred, or a minimum of five years’ comparable experience in a hospital-related…

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
RN Case Manager
Sheakley —Columbus, OH
A current, unrestricted Ohio state licensure or certification in a health or human services discipline that allows the professional to conduct an assessment…
Quick Apply

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in dayton oh

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near dayton oh

Registered Nurse - Utilization Manager

Decypher -
Wright-Patterson AFB, OH

Quick Apply

Job Details

Full-time
$44.92 an hour

Qualifications

Bachelor of Science
Mid-level
2 years
Communication skills

Full Job Description

Join Decypher and make a direct impact on the health and readiness of America’s service members, veterans, and their families. Since 2008 Decypher has offered healthcare industry professionals careers where their expertise is valued, and their work makes a meaningful impact. Decypher partners with the Defense Health Agency to deliver professional services, technology, and management solutions. Our mission is to provide and support quality care for our veterans, servicemembers and their families, across the United States.

Job Summary: The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office equipment and clear verbal and written communication. Must have sufficient visual acuity and attention to detail to analyze complex clinical documentation, with occasional ability to move about the workplace and lift up to 10–15 pounds.

Required Qualifications:

Education:
- Associate degree (ADN) or
- Bachelor of Science in Nursing (BSN) from a program accredited by a national nursing accrediting agency recognized by the U.S. Department of Education.
Certifications:
- Basic Life Support (BLS)
License: Valid, Active, Unrestricted Registered Nurse License
Experience:
- 4 years of experience if ADN holder; 2 years of experience if BSN holder - in discharge planning or case management.
- Full-time employment in a nursing field within the last 36 months is required.

U.S. Citizenship is required

Key Responsibilities:

Assist with inpatient discharge planning as needed, including home safety patient/family
interviews, attending morning planning meetings, and coordinating transfers, home durable medical equipment, home care services, inpatient rehabilitation, and skilled care.
Develop and implement a comprehensive Utilization Management (UM) program aligned with Military Treatment Facility (MTF), Air Force (AF), and Defense Health Agency (DHA) goals and objectives.
Collect, analyze, and trend data/metrics on program areas to identify over- and underutilization of healthcare resources, inefficiencies, and areas for cost containment. Provide reports, feedback, and recommendations in a timely manner.
Monitor specialty care referrals, ensuring appropriateness, covered benefits, and authorization for medical procedures, laboratory, radiology, and pharmacy services.
Evaluate clinical practice patterns and trends, providing feedback to the Chief of Hospital
Services (SGH) and clinical teams.
Identify and refer potential cases to Disease Management, Case Management, Discharge
Planning, and the Deployment Availability Working Group.
Participate in Medical Management, Population Health Working Group, and care coordination meetings as assigned.
Conduct nursing peer reviews as assigned.
Educate Patient-Centered Medical Home (PCMH) staff on the role of Utilization Management.
Assist the PCMH team in notifying patients admitted to civilian hospitals or civilian emergency departments.
Perform medical necessity reviews, including concurrent reviews for length of stay (LOS) using approved clinical decision tools. Assess medical necessity of services and communicate negative trends to the Chief of the Medical Staff.
Navigate electronic health records and TRICARE managed care contractor sites.
Act as referral approval authority for designated referrals based on MTF/AF/DHA national
guidance and standards, including processing and validating durable medical equipment referrals for PRIME beneficiaries and authorizing Supplemental Health Care Program (SHCP) funds for active-duty beneficiaries.
Refer all first-level review failures to SGH or designated points of contact for further review and disposition.
Verify beneficiary eligibility using the Defense Eligibility Enrollment Reporting System
(DEERS). Obtain pertinent patient information and update electronic medical records, local referral databases, and other office automation systems as needed.
Perform other duties as assigned.

Work Environment & Schedule: Monday - Friday; 8 hour shifts 7:00am - 16:30 with a 30-minute uncompensated lunch.

Compensation & Benefits: $44.92 per hour + H&W IF APPLICABLE

Physical requirements:

Decypher is an equal opportunity and affirmative action employer committed to a diverse and inclusive workforce (M/F/D/V)

Quick Apply

Refine Your Search

utilization review nurse jobs in dayton oh

Registered Nurse - Utilization Manager

RN Utilization Rvw Spclst - Utilization Management

CSI ANALYST/SYSTEM SUPPORT-MVH/FT

Utilization Review Coordinator

CASE MANAGER

Case Manager - PRN Days | Miamisburg Rehab

CASE MANAGER / REGISTERED NURSE / RN

Admissions & Medical Records Nurse (LPN, RN)

MDS Nurse Transition Leader

Utilization Management Reviewer

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in dayton oh

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected