Top 16 Utilization review nurse 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
Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
- Full-time
- Nursing
- Microsoft Excel
- English
Quick Apply
RN Case Manager
Sheakley —Columbus, OH
- Full-time
- RN License
- Mid-level
- Organizational skills
Quick Apply
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
10d
RN Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
4d
Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
Nurse Practitioner - PRN
International SOS —Columbus, OH
- $65 an hour
- Weekends as needed
- Nursing
- Writing skills
- BLS Certification
- Health insurance
- Flexible schedule
Quick Apply
Home Health Clinical Manager
Centerwell —Delaware, OH
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
3d
Hiring – Mental Health Nurse Practitioner / LSW / Psychologist (Remote - Ohio)
Wave 2.0 Pvt Ltd —Columbus, OH
- $150,000 - $190,000 a year
- Full-time
- Nursing
- Vital signs
- HIPAA
- Health insurance
- Paid time off
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
10d
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

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Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
Quick Apply

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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…
Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
Quick Apply

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Utilization Review Specialist - Autism

Nationwide Children's Hospital -
Columbus, OH

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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"

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Refine Your Search

utilization review nurse jobs in columbus, oh

Utilization Review Specialist - Autism

Clinical Reviewer - Medical Coder & QA

RN Case Manager

Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)

RN Care Coordinator Endocrinology - PFK (Main)

Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)

Nurse Practitioner - PRN

Home Health Clinical Manager

Hiring – Mental Health Nurse Practitioner / LSW / Psychologist (Remote - Ohio)

Appeals Professional III (Licensed Clinician)

Utilization Management Reviewer

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