Ohio RN Utilization Review Manager

Job Summary

To enhance patient care management, the full-time RN Utilization Review Manager will oversee the utilization management program, ensuring compliance with regulations and effective resource allocation while working remotely from Ohio.

Key responsibilities:

• Reviews patient medical records and assigns status based on Interqual/mcg guidelines, ensuring timely changes in care levels
• Participates in the development and evaluation of the utilization management program, providing education on regulations and resource allocation
• Communicates with third-party payers for authorization of hospital stays and processes requests for appeal of denials

Required qualifications:

• Bachelor's Degree in Nursing from an accredited program
• Current State of Ohio RN licensure
• Basic Life Support (BLS) certification from the American Heart Association
• Crisis Prevention Intervention (CPI) certification within the first 30 days of hire
• Three or more years of clinical experience in a hospital or payer setting