Top 34 Utilization management registered nurse Jobs in Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Customer service
- Writing skills
- Mid-level
- Work from home
PCU Registered Nurse
VieMed Healthcare Staffing —Columbus, OH
- $59.18 an hour
- 12 hour shift
- Acute care
- RN License
- BLS Certification
- Travel reimbursement
- Health insurance
Quick Apply
Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
- $70,000 - $84,000 a year
- Full-time
- Hospital
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
14h
Care Management RN - Outpatient Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Nursing
- RN License
4d
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
12d
Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
Registered Nurse (RN)
ULTIMATE HOME HEALTHCARE LLC —Columbus, OH
- $3,000 - $5,500 a month
- Part-time
- Nursing
- RN License
- 5 years
Quick Apply
RN Case Manager - Part-Time
Mount Carmel —Dublin, OH
- Part-time
- Nursing
- Surgery
- RN License
- Relocation assistance
- Health insurance
20h
RN Case Manager
Mount Carmel —Westerville, OH
- 8 hour shift
- Nursing
- Surgery
- RN License
- Relocation assistance
- Health insurance
RN Care Coordinator Endocrinology - PFK (Main)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
6d
Clinical Specialist
PROCEPT BioRobotics Corporation —Columbus, OH
- $108,000 a year
- Full-time
- Bachelor's degree
- Operating room
- Travel
- Opportunities for advancement
Quick Apply
4d
RN Case Manager
Sheakley —Columbus, OH
- Full-time
- RN License
- Mid-level
- Organizational skills
Quick Apply
Nurse Manager (RN)
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
- $115,000 - $130,000 a year
- 12 hour shift
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Dental insurance
Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
- Full-time
- Nursing
- Microsoft Excel
- English
Quick Apply
Director Nursing - Women's Newborn Services
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- Hospital
Critical Care Transport RN
Nationwide Children's Hospital —Columbus, OH
- From $38.91 an hour
- Part-time
- Nursing
- RN License
- PALS Certification
Manager of Educational Services
MedFlight —Columbus, OH
- From $70,000 a year
- Full-time
- Nursing
- RN License
- PALS Certification
Quick Apply
Director of Clinical Services - Hospice - Weekends - Columbus, Ohio
OhioHealth at Home —Columbus, OH
- Weekends as needed
- Nursing
- RN License
- Writing skills
- Tuition reimbursement
Quick Apply
Rapid Response Nurse-Part-time 24, Nights
OhioHealth —Pickerington, OH
- Part-time
- Acute care
- Nursing
- RN License
5d
Staff RN, Rapid Response, Nights
OhioHealth —Pickerington, OH
- Full-time
- Acute care
- Nursing
- RN License
1d

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utilization management registered nurse jobs near columbus

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 management registered nurse jobs in columbus

Utilization Review Specialist - Autism

PCU Registered Nurse

Case Manager (RN) - Full-Time

Care Management RN - Outpatient Oncology

Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)

Registered Nurse, Care Coordinator - Cerebral Palsy (PFK)

Registered Nurse (RN)

RN Case Manager - Part-Time

RN Case Manager

RN Care Coordinator Endocrinology - PFK (Main)

Clinical Specialist

RN Case Manager

Nurse Manager (RN)

Clinical Reviewer - Medical Coder & QA

Director Nursing - Women's Newborn Services

Critical Care Transport RN

Manager of Educational Services

Director of Clinical Services - Hospice - Weekends - Columbus, Ohio

Rapid Response Nurse-Part-time 24, Nights

Staff RN, Rapid Response, Nights

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