Top 82 Rn utilization Jobs in Columbus

Clinical Financial Case Management RN
The Ohio State University —Columbus, OH
- Full-time
- Remote
- Background check
- Nursing
- Microsoft Excel
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Columbus, OH
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
MDS Coordinator - LVN/RN
Paradigm at Creekside —Gahanna, OH
- Full-time
- Nursing
- Skilled nursing facility
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
PRN RN Case Manager
Interim HealthCare —Columbus, OH
- PRN
- CPR Certification
- Management
- RN License
Quick Apply
12d
RN, LSW, LISW, Care Manager - Columbus
Careforth —Columbus, OH
- $68,700 - $84,200 a year
- Full-time
- Hybrid work
- RN License
- Working with individuals with disabilities
- Mid-level
- Wellness program
- Flexible schedule
14d
Infection Prevention Staff Development IPSD
Majestic Care of Whitehall —Whitehall, OH
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid holidays
- Life insurance
Quick Apply
Oncology Chemo Certified Registered Nurse
VieMed Healthcare Staffing —Columbus, OH
- $65.76 an hour
- 12 hour shift
- Acute care
- RN License
- Hospital
- Health insurance
- Referral program
Quick Apply
Registered Nurse - RN
Paradigm at Creekside —Gahanna, OH
- Full-time
- Nursing
- Microsoft Outlook
- RN License
- Dental insurance
- Paid time off
Quick Apply
Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
- Part-time
- Master of Social Work
- RN License
- Inpatient
- Employee assistance program
- Opportunities for advancement
Quick Apply
RN $10K Sign on Bonus!
Ohio Hospital for Psychiatry —Columbus, OH
- $36 - $40 an hour
- Full-time
- Acute care
- CPR Certification
- Nursing
13d
RN Nursing Informatics - Nursing Informatics
Nationwide Children's Hospital —Columbus, OH
- $38.91 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
Registered Nurse - Urgent Care
US Veterans Health Administration —Columbus, OH
- $70,726 - $148,921 a year
- Weekends as needed
- Acute care
- Background check
- Nursing
- Paid holidays
- Dental insurance
6d
Clinical Finance Case Management Specialist 2
The Ohio State University Wexner Medical Center —Columbus, OH
- Full-time
- Background check
- Nursing
- Pass drug screening
14d
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
7d
Care Manager (RN) - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
- Full-time
- Background check
- Nursing
- RN License
14d
Care Manager RN - Inpatient
The Ohio State University Wexner Medical Center —Columbus, OH
- Full-time
- Background check
- Nursing
- RN License
5d
RN - Occupational Health
OhioHealth —Westerville, OH
- Full-time
- Nursing
- RN License
- BLS Certification
Care Manager (RN) - Outpatient Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Full-time
- Background check
- Nursing
- RN License
Care Manager (RN) - Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Full-time
- 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

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

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

rn utilization jobs near columbus

Clinical Financial Case Management RN

The Ohio State University -
Columbus, OH

Apply Now

Job Details

Full-time

Qualifications

Collaborate with healthcare professionals
Nursing
Writing skills
Copy machines
Bachelor's degree
Fax machines
Desktop applications
Bachelor's degree in nursing
Faxing
Technical Proficiency
Adobe Acrobat
Nursing

Full Job Description

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact [email protected] . If you have questions while submitting an application, please review these frequently asked questions .

Current Employees and Students:

If you are currently employed or enrolled as a student at The Ohio State University, please l og in to Workday to use the internal application process.

Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. In order to ensure your application is complete, you must complete the following:

Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required.
Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application.

Job Title:

Clinical Financial Case Management RN

Department:

Health System Shared Services | Revenue Cycle Clinical Support

Scope of Position

Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for Clinical Pre-Certification, Case Reviews, Pre-billing edits, in-patient account validations, supporting Utilization Management, Peer to Peer processes, complex billing scenarios, audits (governmental, commercial, compliance, and internal), clinical appeals and denial management. RCCS is integral to the Revenue Cycle and supports cash collection through preventing and appealing denials.

Position Summary

Responsible for daily operational management of Revenue Cycle Clinical Support Staff, primarily involving the oversite of Clinical Pre-Certification, Peer to Peer, Clinical Appeals, Denial Analysis and Prevention for The Ohio State University Health System.

Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center. Functions within multidisciplinary teams leading staff to secure complex pre-authorizations and prevent/appeal clinical denials. The job duties require the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided. Makes determinations on the appropriate level of care (Inpatient or Observation) based on the ability to read, understand, and interpret documented clinical information. Is a Subject Matter Experts (SME) for commercial and governmental payer requirements and audits such as RAC, MAC, QIO, etc. Maintains an awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines. Manages escalation processes to administration regarding the need to cancel or reschedule elective surgery when authorization is not secured along with escalations to Managed Care on payer denials.

Is a SME and leads team members in understanding critical components of Managed Care, Scheduling, Financial Counseling, Pre-Certification, Admissions/Discharges/Transfers, Clinical workflows and documentation, Revenue Management, Charge Description Master, Coding (Diagnosis, HCPCS, Revenue Codes, Procedure Codes, Modifiers, etc.), Medical Information Management, Release of Information, Case Management, Utilization Management, Clinical Documentation Improvement, Compliance, Legal, Finance, Transplant workflows, Billing, Follow Up, Cash Posting, and any other areas that maybe needed to understand how to secure authorizations and appeal/prevent denials. Guides staff on how to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal.

Is versatile, flexible, and very adaptable to change because the payer rules change constantly.

Troubleshoots, problem solves, continuously learns, is highly independent, self-motivated and has an elevated level of interpretive skills with the ability to work closely with departments such as Legal, Medical Information Management, Physician groups and the Business Office.

Develops and implements policies, procedures, workflows, and auditing procedures. Serves as a resource on governmental regulatory interpretation. Significant involvement with physicians, physician leaders, and administrators.

Minimum Qualifications

For Hire Required:

Bachelor’s degree in nursing with current license required.

2 years of relevant experience required. 2-4 years of relevant experience preferred.

Experience collaborating with physicians and their designees.

Strong, proven analytical skills. Ability to make educated decisions.

Extensive knowledge of clinical operations and patient flow.

Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing.

Proficient in Microsoft Office Products such as: Word, Power Point, Excel, SharePoint, Teams, OneNote, etc.

Proficient in Adobe Professional Proficient in using email, fax machines, copy machines, internet browsers.

Proficient at typing

Proficient in Technology, Computer, and Web applications. Must be able to multitask and move between applications quickly and frequently. Must be able to orientate self to new applications quickly. Must be able to manage complexities of having to work in multiple applications such as IHIS, MS Office products, 3M, and all payer websites/applications

Additional Information:

Location:

Remote Location

Position Type:

Regular

Scheduled Hours:

Shift:

First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions .

The university is an equal opportunity employer, including veterans and disability.

Apply Now

Refine Your Search

rn utilization jobs in columbus

Clinical Financial Case Management RN

Case Manager, Registered Nurse (Oncology experience required)

MDS Coordinator - LVN/RN

PRN RN Case Manager

RN, LSW, LISW, Care Manager - Columbus

Infection Prevention Staff Development IPSD

Oncology Chemo Certified Registered Nurse

Registered Nurse - RN

Case Manager / PRN ( RN / RT / SW / LPN )

RN $10K Sign on Bonus!

RN Nursing Informatics - Nursing Informatics

Registered Nurse - Urgent Care

Clinical Finance Case Management Specialist 2

Denials RN Coordinator

Care Manager (RN) - Inpatient

Care Manager RN - Inpatient

RN - Occupational Health

Care Manager (RN) - Outpatient Oncology

Care Manager (RN) - Oncology

Care Manager (RN) - IRP - Inpatient

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

Related Searches

Explore jobs in more locations

Job Title:

Department:

Additional Information:

Location:

Position Type:

Scheduled Hours:

Shift:

Job Seeker Tools

Employer Tools

Browse

Stay Connected