Top 22 Rn utilization review Jobs in Columbus

Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
12h
Care Manager (RN) - IRP - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- 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
Care Manager (RN) - Emergency Department
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
RN Case Manager
Sheakley —Columbus, OH
- Full-time
- RN License
- Mid-level
- Organizational skills
Quick Apply
Care Manager (RN) - Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Director of Utilization Management
Mount Carmel —Columbus, OH
- Full-time
- Nursing
- Surgery
- RN License
- Relocation assistance
- Health insurance
1d
RN Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
8d
Care Manager (RN) - Outpatient Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
Staff RN, Rapid Response, Nights
OhioHealth —Pickerington, OH
- Full-time
- Acute care
- Nursing
- RN License
3d
Discharge Planner
SUN Behavioral Columbus —Columbus, OH
- Full-time
- CPR Certification
- LVN
- Writing skills
Quick Apply
9d
Rapid Response Nurse-Part-time 24, Nights
OhioHealth —Pickerington, OH
- Part-time
- Acute care
- Nursing
- RN License
7d
Registered Nurse (RN) – Nurse Manager
Columbus Springs Dublin —Dublin, OH
- Full-time
- Nursing
- RN License
- Inpatient
- Free parking
- Health savings account
Quick Apply
Hospice Clinical Supervisor
Ohio Living —Westerville, OH
- Weekends as needed
- Nursing
- Clean driving record
- Microsoft Excel
Quick Apply
2d
Home Health Clinical Supervisor
Ohio Living —Westerville, OH
- Weekends as needed
- Nursing
- Clean driving record
- Microsoft Excel
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
14d
Project UM Audit & Documentation Director
United States —United States
- Weekends as needed
- LMFT
- Nursing
- RN License
- AD&D insurance
- Paid holidays

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Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
$70,000 - $84,000 a year
Quick Apply
2d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…

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Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department…
$62,500 - $79,800 a year
12h
Care Manager (RN) - IRP - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
RN license and Bachelor of Science in Nursing required. The Clinical Case Manager maintains an awareness of state and national health care trends and…

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Denials RN Coordinator

Ensemble RCM LLC -
Columbus, OH

Apply Now

Job Details

Full-time
$62,500 - $79,800 a year
12 hours ago

Benefits

Tuition reimbursement

Qualifications

Nursing
RN License
Quality assurance
Typing
Nursing

Full Job Description

Thank you for considering a career at Ensemble!

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

CAREER OPPORTUNITY OFFERING:

Bonus Incentives
Paid Certifications
Tuition Reimbursement
Comprehensive Benefits
Career Advancement
This position pays between $62,500.00 - $79,800.00/ based on experience

The Denials RN Coordinator prepares appeals for clinical and technical claim denials across all client hospital facilities. Job duties include but are not limited to: understanding insurance contract terms, reviewing claim denials and underpayments to determine if additional payment amounts can be expected, analyzing medical records and determining if a member or an Independent Review organization (IRO) appeal is necessary, understanding payer medical policy guidelines, preparing IRO appeal documentation which may include correcting and resubmitting claims, gathering additional information, reviewing medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting provider, member and IRO/ALJ appeals in a timely manner. Knowledge and understanding of ERISA compliance laws, healthcare provider and member's legal rights regarding member appeal and grievance processes. Ensures compliance with HIPAA regulations. In addition, the Denials RN Coordinator will work closely with the Clinical Appeal team and Case Management Department to ensure denial trends and outcomes are communicated in a timely manner. Serves as a mentor and provides necessary training and education to Clinical Denial and Underpayment team members. The Denials RN Coordinator will perform these duties while meeting Ensemble principles, as well as meeting the regulatory compliance requirements.

Essential Job Functions:

Denials RN Coordinator primary responsibility is the review of complex claims and escalating clinical or technical claim denials for potential provider, member level or IRO/ALJ appeal.
Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department of Insurance, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner.
Reviewing claim denials and underpayments to determine if additional payment amounts are expected and identifying trends in payment discrepancies amongst payors.
Work closely with the Clinical Denial team and Case Management Department to ensure denial trends and outcomes are communicated in a timely manner.
Acts as a mentor and provides necessary training and education to Clinical Denial and Underpayment team members.
Performs other duties as assigned.

Legally Required License:

Registered Nurse RN

Job Experience:

5 to 7 years

Preferred Knowledge, Skills and Abilities:

4 year/ Bachelors Degree
2 years of denials, utilization review, or case management experience strongly preferred
Must pass typing test of 45 words per minute (error adjusted)
5+ Years of experience in:
Revenue Cycle
Legal nurse consulting
Chart audit/review
Provider relations

Internal Candidate must have met 100% productivity and 100% Quality Assurance, in the previous 3 months
Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

Innovation
Work-Life Flexibility
Leadership
Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble

Apply Now

Refine Your Search

rn utilization review jobs in columbus

Denials RN Coordinator

Care Manager (RN) - IRP - Inpatient

Care Manager (RN) - Inpatient

Care Manager (RN) - Emergency Department

RN Case Manager

Care Manager (RN) - Oncology

Director of Utilization Management

RN Care Coordinator Endocrinology - PFK (Main)

Care Manager (RN) - Outpatient Oncology

Staff RN, Rapid Response, Nights

Discharge Planner

Rapid Response Nurse-Part-time 24, Nights

Registered Nurse (RN) – Nurse Manager

Hospice Clinical Supervisor

Home Health Clinical Supervisor

Appeals Professional III (Licensed Clinician)

Project UM Audit & Documentation Director

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