Top 44 Utilization management program manager rn Jobs in Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
1d
RN - Case Manager
Vibra Travels LLC —Dublin, OH
- $2,157 a week
- Online Application
- Nursing
- RN License
- BLS Certification
- Referral program
Quick Apply
14h
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
- $40.40 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
1d
RN, LSW, LISW, Care Manager - Columbus
Careforth —Columbus, OH
- $62,657 - $84,173 a year
- Full-time
- Hybrid work
- RN License
- Experience working with individuals with disabilities
- Mid-level
- Wellness program
- Flexible schedule
Infection Prevention Staff Development IPSD
Majestic Care of Whitehall —Whitehall, OH
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid holidays
- Life insurance
Quick Apply
10d
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
9d
Utilization Review Specialist
Lighthouse Behavioral Health Solutions —Columbus, OH
- Nursing
- Management
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Care Manager - Part Time - University Hospital
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
13h
Field Clinical Nurse Educator/Neurology - Midwest
Momentum Life Sciences —Columbus, OH
- Nursing
- RN License
- English
Director of Operations Mental Health
REACH Behavioral Health —Columbus, OH
- $68,208.17 - $82,143.17 a year
- Full-time
- Nursing
- Administrative experience
- Organizational skills
Quick Apply
10d
Business Operations Advisor - Access Optimization
OhioHealth —Columbus, OH
- Full-time
- Bachelor's degree
- Mentoring
- Senior level
Manager of Educational Services
MedFlight —Columbus, OH
- From $70,000 a year
- Full-time
- Nursing
- RN License
- PALS Certification
Quick Apply
10d
Registered Nurse - Occupational Health Center
Cetechs —Columbus, OH
- Full-time
- Nursing
- RN License
- BLS Certification
- Wellness program
Quick Apply
Revenue Cycle Manager (Financial Manager) - 20039248
State of Ohio - Behavioral Health —Columbus, OH
- $43.09 an hour
- Online Application
- Background check
- Office
- Finance
- Paid holidays
- Health insurance
RN Case Manager
Mount Carmel —Dublin, OH
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
RN, Care Manager, Doctor's Hospital
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- BLS Certification
Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
Branch Manager
BrightStar Care —Columbus, OH
- $64,404.77 - $79,562.73 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Director Nursing - Women's Newborn Services
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- Hospital

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utilization management program manager rn jobs near columbus

Utilization Review Specialist - Autism

Nationwide Children's Hospital -
Columbus, OH

Apply Now

Job Details

Full-time
1 day ago

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 management program manager rn jobs in columbus

Utilization Review Specialist - Autism

RN - Case Manager

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

RN, LSW, LISW, Care Manager - Columbus

Infection Prevention Staff Development IPSD

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

Utilization Review Specialist

Care Manager - Part Time - University Hospital

Field Clinical Nurse Educator/Neurology - Midwest

Director of Operations Mental Health

Business Operations Advisor - Access Optimization

Manager of Educational Services

Registered Nurse - Occupational Health Center

Revenue Cycle Manager (Financial Manager) - 20039248

RN Case Manager

Denials RN Coordinator

RN, Care Manager, Doctor's Hospital

Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)

Branch Manager

Director Nursing - Women's Newborn Services

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