Ohio Licensed Utilization Nurse

Job Summary

To support healthcare excellence, the full-time Ohio Licensed Utilization Nurse will evaluate medical necessity, collaborate with care teams, and manage authorizations for services in a remote setting.

Key responsibilities:

• Perform initial and concurrent reviews to determine medical necessity using evidence-based criteria
• Validate appropriate patient classification based on CMS regulations and payer requirements
• Coordinate with interdisciplinary care teams and provide timely clinical information to payers

Required qualifications:

• Associate's Degree in Nursing required; BSN must be obtained within 5 years of hire
• 3-4 years of clinical experience in nursing
• Registered Nurse license upon hire is required
• Knowledge of computer programs such as Microsoft Outlook, Word, TEAMS, EPIC, and Voalte
• Membership in a related professional organization is preferred