Top 120 utilization review nurse Jobs in ohio

Utilization Review Clinician
Generations Behavioral Health - Geneva —Geneva, OH
- 8 hour shift
- Background check
- Nursing
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Case Manager - PRN
OhioHealth Rehabilitation Hospital —Columbus, OH
- $40 an hour
- PRN
- Hospital
- Inpatient
- Mid-level
- Opportunities for advancement
16h
Utilization Management Registered Nurse
Humana —Ohio
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Registered Nurse / MDS Coordinator
Confidential —Zanesville, OH
- Full-time
- Anatomy knowledge
- RN License
- Mid-level
Quick Apply
Registered Nurse / MDS Coordinator
Confidential —Marietta, OH
- Full-time
- Anatomy knowledge
- RN License
- Mid-level
Quick Apply
4d
Director of Nursing
North Central Correctional Complex —Marion, OH
- $115,000 a year
- Full-time
- CPR Certification
- Nursing
- Clean driving record
- AD&D insurance
- Paid holidays
5d
MDS Coordinator
Creekside Care Center —Columbus, OH
- $80,000 - $93,000 a year
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Nurse Practitioner - Cincinnati
Clay Consulting —Cincinnati, OH
- $120,000 - $150,000 a year
- Part-time
- Nursing
- RN License
- Customer service
Quick Apply
Nurse Practitioner - Psych (MH/SUD)
Lake-Geauga Recovery Centers, Inc. —Painesville, OH
- Weekends as needed
- Background check
- Nursing
- Psychiatry
- Health savings account
- Health insurance
Quick Apply
3d
PRN RN Case Manager
Interim HealthCare —Columbus, OH
- PRN
- CPR Certification
- Management
- RN License
Quick Apply
9d
Registered Nurse for Coordinator of Medical Services at an ICF Facility
Horizons of Tuscarawas and Carroll Counties, Inc. —Bolivar, OH
- Full-time
- Background check
- Nursing
- Patient monitoring
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse
Amivie Your Home Court Advantage LLC —Shaker Hts, OH
- On call
- Nursing
- Current TB test
- RN License
- Paid holidays
- Health insurance
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
9d
Assistant Director of Nursing ADON/MDS Nurse RN
The Pavilion at Stow Nursing and Rehabiliation —Stow, OH
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- 401(k)
- Paid time off
Quick Apply
14d
Registered Nurse Supervisor
Medical Recruitment Strategies —Georgetown, OH
- $36 - $39 an hour
- Full-time
- Anatomy knowledge
- PALS Certification
- BLS Certification
Quick Apply
4d
Care Manager Assistant - LPN
Mayfair Village Nursing Care Center —Columbus, OH
- Full-time
- Nursing
- Customer service
- Sanitation
Quick Apply
MDS Nurse RN
The Pavilion at Edgefield for Nursing and Rehabilitation —Canton, OH
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- 401(k)
- Paid time off
Quick Apply
Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Akron —Akron, OH
- Part-time
- Master of Social Work
- RN License
- Inpatient
- Employee assistance program
- Opportunities for advancement
Quick Apply
4d
Case Manager ( RN / RT / SW / LPN )
Select Specialty Hospital - Akron —Akron, OH
- Full-time
- RN License
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
14d
RN Case Manager
Interim HealthCare —Cambridge, OH
- $70,000 - $75,000 a year
- Full-time
- CPR Certification
- Management
- RN License
Quick Apply
1d

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utilization review nurse jobs near ohio

Utilization Review Clinician

Generations Behavioral Health - Geneva -
Geneva, OH

Quick Apply

Job Details

Full-time

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Life insurance

Qualifications

BLS Certification
Administrative experience
Medical administrative support
Medical records
Case management
Video conferences (communication methods)
Hospital experience

Full Job Description

Job Summary

Under the direction of the UTILIZATION REVIEW MANAGER, the Utilization Review (UR) Clinician will maximize covered/authorized inpatient days through coordination of care impacting length of stay, patient medical necessity, and appropriate discharge. The UR Clinician will be responsible for understanding, administering, and compliance for ALL Payer Inpatient Psychiatric Criteria including CMS Conditions of Participation, all GBH policies and procedures.

Position Qualifications

Current, valid, and active BSN, LPN or LSW.
Prior hospital case management or relevant experience preferred.
Current BLS certification required through the American Heart Association or completion of Generations Behavioral Health's BLS course upon hiring

Responsibilities

Thorough knowledge of medical necessity criteria for Medicare, Medicaid, HMO and private insurance payers related to Inpatient Psychiatric services.
Use of standardized clinical templates, use of payer portals, and live reviews.
Accurately obtain third party prior authorizations via payer portals, fax, or verbal communication, Continued Stay Reviews/pre-authorization extensions, and/or retro-active authorizations.
Prepare and coordinate with Clinical staff regarding Peer-to-Peer appeals and 1st Level appeals.
Participate in daily meetings and huddles in person, via telephone, or video conference to provide communication regarding covered days, upcoming authorization extensions, denials and provider plans for a timely discharge.
Utilization Electronic Medical Record (EMR) and Practice Management (PM) software.
Execute various hard or electronic paperwork, information files processing, fax documents, mail and other daily administrative tasks.
Develop and maintain positive relationships with third party Prior Authorization staff.
Ability to identify and resolve problems effectively and efficiently.
Maintain an efficient, organized work environment.
Effectively manage difficult customer situations; responds to requests for service and assistance.
Maintain current knowledge of emergencies and disaster procedures of the facility.
Participate in hospital-wide safety program identifying risks to patient safety and reducing healthcare errors.
Ability to carry out essential functions of this position with or without reasonable accommodation.
Perform other duties as assigned.

Working Conditions

Work occurs in a fast-paced psychiatric inpatient setting with patients who may display unpredictable or aggressive behaviors and must use de-escalation skills and follow safety protocols. The role requires frequent standing, walking, sitting, occasional lifting or assisting patients and the ability to respond quickly to emergencies while performing clinical tasks.

Job Details

Full time
8-hour shifts
Pay is based on experience
Our Electronic Medical Record system is WellSky

EEO Statement

We are an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, military service, political affiliation, genetic information or other non-merit-based factors.

Applicants requiring accommodation(s) during the application and or hiring process, may contact us for assistance. Employment is at-will. Employment is contingent upon background checks, pre-employment substance testing and verification of work authorization.

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

utilization review nurse jobs in ohio

Utilization Review Clinician

Case Manager - PRN

Utilization Management Registered Nurse

Registered Nurse / MDS Coordinator

Registered Nurse / MDS Coordinator

Director of Nursing

MDS Coordinator

Nurse Practitioner - Cincinnati

Nurse Practitioner - Psych (MH/SUD)

PRN RN Case Manager

Registered Nurse for Coordinator of Medical Services at an ICF Facility

Registered Nurse

Nurse Practitioner

Assistant Director of Nursing ADON/MDS Nurse RN

Registered Nurse Supervisor

Care Manager Assistant - LPN

MDS Nurse RN

Case Manager / PRN ( RN / RT / SW / LPN )

Case Manager ( RN / RT / SW / LPN )

RN Case Manager

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