Top 58 & utilization review Jobs in Columbus, Oh

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
Homecare Prior Authorization Supervisor
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
- $24 - $32 an hour
- Full-time
- Nursing
- Adults
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
Clinical Quality Auditor Contingent/IRP
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
Dental Office Manager
Norton Family Dental —Columbus, OH
- From $26 an hour
- Full-time
- Nursing
- Dental office
- BLS Certification
- Health savings account
- Health insurance
Quick Apply
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
Medicaid Medical Director (Physician Administrator 3)
State of Ohio - Medicaid —Columbus, OH
- Full-time
- Medicine
- Driver's License
- Travel
- Paid holidays
- Health insurance
Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
- Full-time
- Nursing
- Microsoft Excel
- English
Quick Apply
14d
Assistant Medicaid Medical Director (Physician Administrator 2)
State of Ohio - Medicaid —Columbus, OH
- Full-time
- Medicine
- Driver's License
- Travel
- Paid holidays
- Health insurance
Business Office Manager
Convalarium Care Center —Dublin, OH
- $65,000 a year
- Full-time
- HIPAA
- Mid-level
- Office
- Loan repayment program
- Health insurance
Quick Apply
Client Insurance Specialist
Integrated Services for Behavioral Health —Columbus, OH
- $20.97 - $24.56 an hour
- Hybrid work
- Mid-level
- Organizational skills
- 2 years
- Disability insurance
- Health insurance
Quick Apply
OhioRISE Navigator- Inpatient & Community Transitions
I Am Boundless, Inc. —Delaware, OH
- $49,895 - $60,114 a year
- Full-time
- Background check
- Nursing
- Pass drug screening
- Paid holidays
- Disability insurance
Quick Apply
Discharge Coordinator, Behavioral Health
Columbus Springs Dublin —Dublin, OH
- Part-time
- CPR Certification
- BLS Certification
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
2h
Community Behavioral Health Worker
Integrated Services for Behavioral Health —Columbus, OH
- $19.00 - $22.26 an hour
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Quick Apply
Family Preservation Clinical Supervisor
Mentor Behavioral Health —Columbus, OH
- $75,000 a year
- Full-time
- Master of Social Work
- Mid-level
- Analysis skills
- Paid holidays
- Paid time off
CDCA Case Manager – Substance Use Treatment
Seacrest Recovery Center —Columbus, OH
- $20 - $22 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
4d
MDS Nurse
Sapphire Rehabilitation & Care Center —Columbus, OH
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Disability insurance
- Health insurance
Quick Apply
9d
RN Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
1d
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
RN Case Manager
Sheakley —Columbus, OH
- Full-time
- RN License
- Mid-level
- Organizational skills
Quick Apply

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& utilization review jobs near columbus, oh

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 jobs in columbus, oh

Utilization Review Specialist - Autism

Homecare Prior Authorization Supervisor

UR Coordinator, Full Time

Clinical Quality Auditor Contingent/IRP

Dental Office Manager

OhioRISE CME Care Coordinator Supervisor I

Medicaid Medical Director (Physician Administrator 3)

Clinical Reviewer - Medical Coder & QA

Assistant Medicaid Medical Director (Physician Administrator 2)

Business Office Manager

Client Insurance Specialist

OhioRISE Navigator- Inpatient & Community Transitions

Discharge Coordinator, Behavioral Health

Community Behavioral Health Worker

Family Preservation Clinical Supervisor

CDCA Case Manager – Substance Use Treatment

MDS Nurse

RN Care Coordinator Endocrinology - PFK (Main)

Clinical Supervisor

RN Case Manager

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