Ohio Licensed Utilization Management Nurse

Job Summary

To support pediatric care, the full-time Ohio Licensed Utilization Management Nurse will conduct medical necessity reviews, manage denials and compliance, and collaborate with interdisciplinary teams, working remotely with a schedule of 7am-4:30pm.

Key responsibilities

• Conduct utilization reviews to determine appropriate levels of care and validate admission statuses
• Manage denial processes and contribute to quality improvement initiatives within the department
• Engage in interdisciplinary collaboration to support care progression and address discharge barriers

Required qualifications

• Bachelor's in nursing (BSN) required, or must be obtained within 5 years of hire
• Registered Nurse licensure in Ohio required
• Minimum of 3 years of relevant nursing experience required
• Experience in inpatient clinical settings is required; pediatric experience preferred
• Proficiency in MS Office applications (Outlook, Excel, Word) required