Top 72 Rn utilization 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
Registered Nurse
Mount Carmel Behavioral Health —Columbus, OH
- $36.00 - $44.75 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
1d
RN, Case Manager
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- BLS Certification
1d
RN Case Manager
Mount Carmel —Westerville, OH
- 8 hour shift
- Nursing
- Surgery
- RN License
- Relocation assistance
- Health insurance
Regional Education Specialist
l'Oréal —Columbus, OH
- Full-time
- Bilingual
- Microsoft Word
- Nursing
- On-the-job training
Quick Apply
11d
RN Case Manager - Part-Time
Mount Carmel —Dublin, OH
- Part-time
- Nursing
- Surgery
- RN License
- Relocation assistance
- Health insurance
3d
Psychiatric Crisis Department Charge RN - Weekend Option (Days)
Nationwide Children's Hospital —Columbus, OH
- $50.80 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Care Manager (RN) - Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Care Manager (RN) - Outpatient Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Care Manager (RN) - IRP - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
RN Care Manager
OhioHealth —Columbus, OH
- Full-time
- CPR Certification
- Nursing
- RN License
1d
RN Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
9d
Critical Care Transport RN
Nationwide Children's Hospital —Columbus, OH
- From $38.91 an hour
- Part-time
- Nursing
- RN License
- PALS Certification
Psychiatric Charge RN- Adolescent Unit- Weekend Option- Day Shift
Nationwide Children's Hospital —Columbus, OH
- $50.80 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Charge RN - Psychiatric Crisis Department (Evenings)
Nationwide Children's Hospital —Columbus, OH
- From $39.90 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
14d
Care Manager (RN) - Emergency Department
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Care Manager (RN) - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Clinical Finance Case Management Specialist 2
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Hybrid work
- Background check
- Nursing
- Pass drug screening
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- Patient monitoring
- RN License

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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

rn utilization jobs in columbus, oh

Utilization Review Specialist - Autism

Registered Nurse

Denials RN Coordinator

RN, Case Manager

RN Case Manager

Regional Education Specialist

RN Case Manager - Part-Time

Psychiatric Crisis Department Charge RN - Weekend Option (Days)

Care Manager (RN) - Oncology

Care Manager (RN) - Outpatient Oncology

Care Manager (RN) - IRP - Inpatient

RN Care Manager

RN Care Coordinator Endocrinology - PFK (Main)

Critical Care Transport RN

Psychiatric Charge RN- Adolescent Unit- Weekend Option- Day Shift

Charge RN - Psychiatric Crisis Department (Evenings)

Care Manager (RN) - Emergency Department

Care Manager (RN) - Inpatient

Clinical Finance Case Management Specialist 2

Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)

I want to receive the latest job alert for rn utilization in columbus, oh

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