Top 21 Utilization management nurse Jobs in Kettering 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
RN-Care Management and Services
Kettering Health —Miamisburg, OH
- Weekends as needed
- Acute care
- Nursing
- RN License
7d
CASE MANAGER
Miami Valley Hospital —Dayton, OH
- Full-time
- Nursing
- RN License
- Hospital
Hybrid RN Case Manager
Agilon Health —Miamisburg, OH
- Full-time
- Nursing
- OSHA
- RN License
9d
CSI ANALYST/SYSTEM SUPPORT-MVH/FT
System Support —Dayton, OH
- Full-time
- Microsoft Word
- Nursing
- RN License
Certified Wound Care Clinician/Nurse
Gentell —Dayton, OH
- Full-time
- Nursing
- RN License
- Sales
- Opportunities for advancement
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NP-PSYCHIATRY-SBHI
Samaritan Behavioral Health In —Dayton, OH
- Part-time
- CPR Certification
- Nursing
- Doctoral degree
RN ~ PACU Liberty
Cincinnati Children's Hospital —Township of Liberty, OH
- Full-time
- Nursing
- RN License
- 5 years
11d
MDS Nurse Transition Leader - RN
Otterbein SeniorLife —Springboro, OH
- Nursing
- RN License
- 5 years
- Paid holidays
- Dental insurance
Quick Apply
5d
RN Clinical Manager – Ambulatory Subspecialty Sites
Cincinnati Children's Hospital —Township of Liberty, OH
- $100,526.40 - $130,686.40 a year
- 8 hour shift
- Nursing
- RN License
- Clinic experience

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RN Utilization Rvw Spclst - Utilization Management
Kettering Health —Miamisburg, OH
Participates in design of work flows and procedure to reduce incidence of denials. 5 years clinical experience with 2 years case management.

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HomeCaire of Ohio (CIN) —Logan, OH
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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 management nurse jobs in kettering oh

Registered Nurse - Utilization Manager

RN Utilization Rvw Spclst - Utilization Management

RN-Care Management and Services

CASE MANAGER

Hybrid RN Case Manager

CSI ANALYST/SYSTEM SUPPORT-MVH/FT

Certified Wound Care Clinician/Nurse

NP-PSYCHIATRY-SBHI

RN ~ PACU Liberty

MDS Nurse Transition Leader - RN

RN Clinical Manager – Ambulatory Subspecialty Sites

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