Ohio Licensed Utilization Management Nurse

Job Summary

To support effective healthcare delivery, the full-time remote Ohio Licensed Utilization Management Nurse will conduct medical necessity reviews, manage denials and compliance, and collaborate with interdisciplinary teams to ensure appropriate utilization of hospital resources.

Key responsibilities

• Conduct Utilization Review & Determine Appropriate Level of Care by applying evidence-based medical necessity criteria
• Manage Denials, Compliance, and Quality Improvement Activities to enhance departmental workflows
• Support Care Progression Through Interdisciplinary Collaboration by engaging in daily huddles and patient care discussions

Required qualifications

• Bachelor's in nursing (BSN) is required
• Registered Nurse licensure is required
• 3 years of relevant experience in inpatient clinical settings is required
• Experience in pediatrics is preferred
• Proficiency in MS Office (Outlook, Excel, Word) or similar software is required