Top 59 & utilization review Jobs in Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
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
Homecare Prior Authorization Supervisor
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
Occupational Therapist
BoldAge PACE —Columbus, OH
- Full-time
- Pass drug screening
- Mid-level
- Clinic
- Health insurance
- Dental insurance
Quick Apply
14d
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
Discharge Coordinator, Behavioral Health
Columbus Springs Dublin —Dublin, OH
- Part-time
- CPR Certification
- BLS Certification
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
6h
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
Assistant Medicaid Medical Director (Physician Administrator 2)
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
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
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
Service Line Manager- COPC Sports, Spine & Joint
Central Ohio Primary Care Physicians,Inc —Westerville, OH
- OSHA
- Computer literacy
- Urgent Care
Quick Apply
4h
Medicaid Medical Director (Physician Administrator 3)
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
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
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
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 Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
2d
Discharge Planner
SUN Behavioral Columbus —Columbus, OH
- Full-time
- CPR Certification
- LVN
- Writing skills
Quick Apply
2d

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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

& utilization review jobs in columbus

Utilization Review Specialist - Autism

UR Coordinator, Full Time

Clinical Quality Auditor Contingent/IRP

Homecare Prior Authorization Supervisor

Occupational Therapist

Family Preservation Clinical Supervisor

Discharge Coordinator, Behavioral Health

OhioRISE Navigator- Inpatient & Community Transitions

Assistant Medicaid Medical Director (Physician Administrator 2)

Clinical Reviewer - Medical Coder & QA

Client Insurance Specialist

Community Behavioral Health Worker

Service Line Manager- COPC Sports, Spine & Joint

Medicaid Medical Director (Physician Administrator 3)

Business Office Manager

CDCA Case Manager – Substance Use Treatment

OhioRISE CME Care Coordinator Supervisor I

Clinical Supervisor

RN Care Coordinator Endocrinology - PFK (Main)

Discharge Planner

I want to receive the latest job alert for & utilization review in columbus

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