Top 67 Utilization review case 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
Appeals and Grievances Specialist
Sidecar Health —Columbus, OH
- $65,000 - $75,000 a year
- Remote
- Mid-level
- 3 years
- Analysis skills
- Paid holidays
- Health insurance
Quick Apply
2d
Outpatient Intake Assessment Specialist
Highlife Recovery —Columbus, OH
- $60,000 - $70,000 a year
- Full-time
- Hybrid work
- LMFT
- Psychiatry
- Pass drug screening
- 401(k)
- Paid time off
Quick Apply
5d
IOM Technologist-Cincinnati, OH
MPOWERHealth —Ohio
- On call
- CPR Certification
- Anatomy knowledge
- Surgery
- Paid training
- Health savings account
Quick Apply
Care Manager - Inpatient - Oncology
The Ohio State University Wexner Medical Center —Columbus, OH
- Part-time
- Background check
- Nursing
- RN License
2d
Case Manager
Phoenix Group Home, LLC —Lancaster, OH
- Full-time
- Writing skills
- HIPAA
- Mid-level
Quick Apply
RN Case Manager
Sheakley —Columbus, OH
- Full-time
- RN License
- Mid-level
- Organizational skills
Quick Apply
Kinship and Placement Supervisor
THE VILLAGE NETWORK —Columbus, OH
- $65,202 - $69,860 a year
- Full-time
- Master of Social Work
- Mid-level
- Office
- Paid holidays
- Paid time off
MPPS Policy Deviations Senior Manager
CVS Health —Columbus, OH
- $67,900 - $182,549 a year
- Full-time
- Nursing
- 5 years
- Bachelor's degree
- Health insurance
- Dental insurance
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
Discharge Planner
SUN Behavioral Columbus —Columbus, OH
- Full-time
- CPR Certification
- LVN
- Writing skills
Quick Apply
4d
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
6d
Sr Supply Chain Coordinator
The Ohio State University Wexner Medical Center —Columbus, OH
- Online Application
- Background check
- Pass drug screening
- Mid-level
- Paid parental leave
- Disability insurance
9d
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
Clinician - Franklinton
BASECAMP RECOVERY LLC —Columbus, OH
- $24 an hour
- Weekends as needed
- LMFT
- Spanish
- CPR Certification
- Paid holidays
- Health insurance
Quick Apply
11d
Clinician (Counselor) - Franklinton
Basecamp Recovery Center —Columbus, OH
- $26 - $38 an hour
- Weekends as needed
- LMFT
- Spanish
- CPR Certification
- Paid holidays
- Loan repayment program
Quick Apply
Program Manager
Equitas Health, Inc. —Columbus, OH
- $58,700 - $73,300 a year
- Weekends as needed
- Public speaking
- HIPAA
- Mid-level
Quick Apply
Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Nursing
- RN License
- Computer literacy
10d
County Supervisor
Integrated Services for Behavioral Health —Circleville, OH
- $48,596.66 - $79,175.95 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Disability insurance
- Health insurance
Quick Apply

I want to receive the latest job alert for utilization review case 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

utilization review case 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 review case jobs in columbus

Utilization Review Specialist - Autism

UR Coordinator, Full Time

Appeals and Grievances Specialist

Outpatient Intake Assessment Specialist

IOM Technologist-Cincinnati, OH

Care Manager - Inpatient - Oncology

Case Manager

RN Case Manager

Kinship and Placement Supervisor

MPPS Policy Deviations Senior Manager

OhioRISE CME Care Coordinator Supervisor I

Discharge Planner

CDCA Case Manager – Substance Use Treatment

Sr Supply Chain Coordinator

Clinical Supervisor

Clinician - Franklinton

Clinician (Counselor) - Franklinton

Program Manager

Registered Nurse Care Coordinator - Fostering Connections Clinic (PFK)

County Supervisor

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

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected