298 Results for

Utilization Management Nurse Jobs in Ohio

Jobs

Wooster, OH

To qualify as a Registered Nurse Case Manager (RNCM) with us, you will need: Licensure: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position . We take a patient-centric approach to address each individual's mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace.

8 days ago

Columbus, OH

8 days ago

Cambridge, OH

$70,000–$75,000

4 days ago

Columbus, OH

Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed. Teach participants, caregivers and families about self-care, medications, healthy lifestyles, infection control and safety to promote optimal health and safety.

1 day ago

Moraine, OH

Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. . Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed.

1 day ago

COLUMBUS, OH

Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator. The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned.

Today

Wilmington, OH

$71,677–$107,516 / year

Quality Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation . Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes .

1 day ago

Columbus, OH

$60,522–$129,615

Manage transitions of care episodes for patients on their panel, including timely completion of structured clinical assessments to identify post-discharge needs, medication reconciliation on behalf of the PCP, and addressal of identified needs directly or via collaboration with other team members. In partnership with the primary care provider, (PCP), the RN, Care Manager is the lead for care management activities, drives care coordination and collaborates with interdisciplinary teams to ensure care continuity for complex patients.

2 days ago

Unionport, NY

Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.

7 days ago

South Madison, WI

Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.

8 days ago

DEFIANCE, OH

Today

DEFIANCE, OH

Today

Hiram, OH

Ability to read, write and speak English language, optimize the use of technology to support clinical care and holds basic computer skills Strong interpersonal, collaborative skills along with customer service skills required; Ability to function in a fast paced environment and respond to emergencies in using a decisive, composed and respectful manner; Possess excellent time management skills; practices nursing using evidence and analytical skills practices nursing using evidence and analytical skills along with possessing strong critical thinking skills. Exemplary Practice and Outcomes A. Performs the Nursing Process (assessment; diagnosis; identification of outcomes; planning; implementation and evaluation) in the performance of clinical care using evidence base practice, uses analytical/critical thinking and ensuring that care is individualized; coordinating care through effective partnerships recognizing that caring is central to achieve optimal patient care outcomes B.

9 days ago

Delaware, OH

The Community Outreach Population Health Nurse Practitioner (NP) will provide primary health care and behavioral health services as a member of a healthcare team comprised of Behavioral Health and Community Outreach RNs, Peers, Community Health Workers, and drivers. Provides primary care directly on a mobile health clinic, emphasizing accessibility, health promotion, illness prevention and continuity of care to patients presenting with both minor and complex health issues.

9 days ago

Moraine, OH

Performs integrated IDT functions encompassing the Occupational Therapist role and the Home Care Coordinator role, ensuring cohesive planning, communication, and oversight of both rehabilitative and home-based support services for PACE participants. Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. .

6 days ago

Cincinnati, OH

Coach fellow providers in how to provide excellent primary care / urgent care / or community care to their members and effectively lead their interdisciplinary care teams. Work in a team environment (with social work, care management, behavioral health, nursing, pharmacy, nutrition, etc.), process feedback, and facilitate discussion and implementing plans of care from other members of the team.

2 days ago

Akron, OH

$37.40–$56.11 / hour

Broad understanding of Utilization Management concepts that include, but are not limited to: Traditional Medicare and Medicaid Regulations and Requirements, Medicare Two Midnight Rule, Condition Code 44, Condition Code W2, Important Message From Medicare, HINN 12 Letters, Medicare Inpatient only Procedure List; Knowledge of Payer Types, Worker's Compensation, Veteran's Administration, DRG reimbursement, Outlier reimbursement agreements, Commercial insurance plan types: PPO, POS, HMO, Medicare Open Plans, Marketplace Plans, Carve out for Services, Indigent Plans, Institutional Accounts, ICD-10 codes. Exceptional candidates gravitate to Summa because of its culture, passion for delivering excellent service to our patients and families commitment to our philosophy of servant leadership, collegial working relationships at every level of the organization and competitive pay and benefits.

6 days ago

Work At Home, OH

$29.10–$62.32 / hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

4 days ago

Kettering, Ohio

The Care Coordinator will perform duties to support the specific population(s) identified including, but not limited to: patient outreach, chart review, coordination of services, care plan support, running data and dashboard analysis, and communication to team members. Key improvements the Care Coordinator will focus on include: improved access, optimized utilization management, proactive panel management, quality outcomes of disease management, and excellent customer experience.

30+ days ago

Middleburg Heights, OH

$1,880–$2,160

Seeking an experienced RN Utilization Manager to support clinical reviews and care coordination in an acute care setting. The ideal candidate will have a strong background in clinical nursing, case management, and utilization management.

1 day ago

Remote

The AVP supports the execution of enterprise utilization management strategy, oversees day-to-day operational performance across assigned programs or service lines, and leads managers and senior leaders responsible for utilization review, authorization, and medical necessity processes. The Assistant Vice President, Utilization Management provides senior operational leadership for utilization management programs, supporting enterprise strategies focused on regulatory compliance, clinical documentation integrity, and reimbursement optimization.

6 days ago

Middleburg Heights, OH

$2,000–$2,200

Previous experience with screening criteria Cerner, InterQual, and MCG . Schedule: Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p.

1 day ago

Wright-Patterson AFB, OH

interviews, attending morning planning meetings, and coordinating transfers, home durable medical equipment, home care services, inpatient rehabilitation, and skilled care. Collect, analyze, and trend data/metrics on program areas to identify over- and underutilization of healthcare resources, inefficiencies, and areas for cost containment.

30+ days ago

West Chester, OH

Identify actual and potential delays in service and works with the appropriate individuals, including but not limited to, the patient, family, caregivers, Access Team, Social Work, Financial Counseling, and Quality Management Services to ensure timely action/resolution. Provide ongoing consultation and training to medical staff and other healthcare professionals on discharge and home care issues; participate in process improvement activities; identify barriers in service delivery systems and develop a process for improvement.

11 days ago

Newark, OH

The Case Manager develops collaborative, outcome-oriented plans of care for each patient, acts as a patient advocate and provides mechanisms and support to empower patients to make responsible healthcare decisions while guiding appropriate utilization of resources and services to achieve expected outcomes. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

6 days ago

Newark, OH

The Case Manager develops collaborative, outcome-oriented plans of care for each patient, acts as a patient advocate and provides mechanisms and support to empower patients to make responsible healthcare decisions while guiding appropriate utilization of resources and services to achieve expected outcomes. The case manager is responsible for individualized management of hospital and healthcare services necessary and appropriate to the provision of high quality, cost effective patient care.

6 days ago

Chillicothe, OH

Effective acute care Case Management includes but is not limited to the following: Assessing patient needs while evaluating health risks; Developing a comprehensive discharge plan that meets all of the patient''s needs; Coordinating all appropriate disciplines in the patient care; Optimizing utilization management of resources; Performing interventions to reduce hospital length of stays and decrease readmission rates; and Ensuring that all post-acute care services are arranged prior to discharge. The Registered Nurse (RN) Case Manager works collaboratively with multidisciplinary teams across the continuum of care to serve as patient advocates that support, guide and coordinate care for patients, families and caregivers.

11 days ago

Columbus, OH

In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.

18 days ago

Huber Heights, Ohio

Overview: North Valley Behavioral Hospital, a brand new psychiatric hospital within the NeuroPsychiatric Hospitals network, is looking for a Utilization Review Coordinator to coordinate patients’ services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams. Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.

5 days ago

Cincinnati, OH

Full time

30+ days ago

Cincinnati, OH

6 days ago

West Chester, OH

10 days ago

Marion, OH

Full time

Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including residents/families/caretakers, physicians, nurse and other ancillary partners. Certificates, Licenses, Registrations LVN/LPN Valid License or RN Valid Licensee in the state you are working.

30+ days ago

West Chester, OH

Full time

30+ days ago

Akron, OH

$34–$50.99 / hour

Coordinate the delivery of services in the most appropriate setting, and provide support for transitions between settings for plan members that meets organizational goals related to quality outcomes, member experience, and cost-efficiency, using approved medical criteria and regulatory guidelines. Evaluates targeted members for use of appropriate in-network providers, provides assistance in gaining access to in-network providers to achieve desired utilization and quality outcomes.

30+ days ago

Moraine, OH

Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed.

18 days ago

Columbus, OH

13 days ago

Beavercreek, OH

30+ days ago

Willoughby, OH

Full time

30+ days ago

Chillicothe, OH

The Nurse Manager leads a team of care providers in an assigned area(s) cultivating collaboration, enthusiasm, and mutual respect while providing patient care and supportive services directed towards achievement of positive patient care outcomes, maximizing the patient's involvement in his/her own plan of care, improving service levels, reducing the length of hospitalization, and decreasing costs. The Nurse Manager is responsible for managing, guiding, coaching, and evaluating the work performance of patient care staff in their designated area(s), ensuring ongoing collaboration with other departments/areas that relate directly or indirectly to patient care operations.

30+ days ago

Cincinnati, OH

The Case Manager utilizes advanced nursing skills and knowledge of resource management and fiscal responsibility to coordinate the clinical care for a designated patient population across the continuum of care. The Case Manager interacts with Medical, Nursing and Ancillary department staff to facilitate quality based, cost effective patient outcomes and ensure care is provided in the most appropriate setting.

19 days ago

Georgetown, OH

Responsibilities include but are not limited to: Supervises direct care nursing staff (e.g., completes & signs performance evaluations & handles disciplinary issues, provides counseling, assigns & monitors work, recruits, interviews & recommends applicants for hire; trains & orients new employees; develops & provides in-service training); assists in planning, directing & evaluating all nursing care services; establishes & implements nursing care programs; reviews & updates current programs; serves as nursing liaison with other units to ensure services are coordinated; directs record keeping & reporting procedures; coordinates nursing services with other resident services; conducts &/or attends health care meetings; provides leadership for quality assurance functions & requisitions medical supplies or equipment; communicates with resident families, physicians & specialists; investigates care/abuse complaints. '',''Southern Ohio Veteran''s Home'',''2003 Veterans Boulevard'','''',''Georgetown'',''45121-0000'',''United States of America-OHIO-Brown County-Georgetown'',''United States of America-OHIO-Brown County-Georgetown'','''','''',''$43.09'',''$43.09'',''Full-time'',''Full-time'',''11pm-7:30am'',''11pm-7:30am'',''Classified'',''Classified'',''Exempt from Union'',''Exempt from Union'',''Nursing'',''Nursing'',''Nursing, Operational and Administrative Support'',''Nursing, Operational and Administrative Support'',''Attention to Detail, Critical Thinking, Leading Others, Teamwork, Confidentiality'',''Attention to Detail, Critical Thinking, Leading Others, Teamwork, Confidentiality'','''','''',''!*!

20 days ago

Columbus, OH

$85,000–$95,000

This position is responsible for assessing patient needs, developing and implementing care plans, coordinating services, and evaluating outcomes to ensure holistic and high-quality healthcare delivery. Monitor and manage both acute and chronic patient conditions in various settings, promoting continuity of care and supporting transitions between home, assisted living, nursing, or hospital care as needed.

1 day ago

Columbus, OH

$85,000–$95,000

1 day ago

Akron, OH

This classification description is intended to indicate the general kinds of tasks and levels of work difficulty that are required of positions given this title and should not be construed as declaring what the specific duties and responsibilities of any particular position shall be. Participates in establishing the functions and qualifications for each service position; coordinates interdisciplinary team services: Assures ongoing assessment of patient/family needs and implementation of interdisciplinary group plan of care.

5 days ago

Beachwood/Shaker Hts., Ohio

The Registered Nurse is accountable for ensuring the overall quality and appropriateness of patient care and nursing services for all home care clients as assigned. Notify appropriate branch personnel of patient acceptance for home care and provide intake data, essential background information, care plan, and signed physician orders.

25 days ago

Canton, OH

Responsible for the continuous review of the care of every patient on his/her caseload (average 20-25 patients) to include: appropriate utilization of services; ensuring continues skilled need and homebound status as required by the payer, review of documentation in the medical record, maintenance of interdisciplinary communication and discharge planning. The RN supervises the care provided by individuals such as licensed practical nurses, patient care technicians/state tested nursing assistants/nurse aides, medical assistants, and etc., if applicable.

30+ days ago

Marion, OH

Demonstrate an understanding of the following psychiatric disorders in planning nursing care for patients: organic, schizophrenic, personality, depressive, bipolar, anxiety, obsessive/compulsive, disruptive behavior, eating, developmental, adjustment, psychoactive substance use, somatoform, dissociative, factitious and post-traumatic stress. Perform rescue functions at accidents, emergencies and disasters to include administering basic emergency medical aid, physically removing people away from dangerous situations, and securing and evacuating people from confined areas.

30+ days ago

Seven Hills, OH

Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states. The Nurse Care Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

6 days ago

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Utilization Management Nurse Jobs in Ohio

RN Case Manager ( Wayne County) Interim HealthCare

PRN RN Case Manager Interim HealthCare

RN Case Manager Interim HealthCare

RN Care Manager - Hourly- Per Diem BoldAge PACE

RN Care Manager - Exempt BoldAge PACE

MDS Nurse (RN/LPN) The Laurels of Walden Park

PRN Registered Nurse Optum

Registered Nurse - Case Manager - Columbus Ohio Oak Street Health

Medical-Surgical Registered Nurse (Med-Surg RN) Yale New Haven Health

Case Manager Encompass Health Rehabilitation Hospital of Fitchburg

MDS Nurse (RN) - Sign On Bonus The Laurels of Defiance

MDS Nurse (RN) The Laurels of Defiance

Registered Nurse (RN) -Acute Care- Cardiac/Telemetry/Renal Fulltime 7p-7a Wellstar Health System

ADVANCED PRACTICE CLINICIAN - COMMUNITY OUTREACH-POPULATION HEALTH NURSE PRACTITIONER Beebe Healthcare

Occupational Therapist BoldAge PACE

Lead Physician, Primary Care AbsoluteCare

RN Utilization Management SummaCare Inc

Utilization Management Nurse Consultant CVS Health Corp

LPN Care Coordinator-UTILIZATION MGMT Kettering Health

RN – Utilization Manager Talented Medical Solutions

AVP, Utilization Management Ensemble Health Partners

RN Utilization Manager Talented Medical Solutions

Registered Nurse - Utilization Manager Decypher

RN Case Manager, Clinical Case Management, Part Time, First Shift UC Health

RN Case Manager - Case Management (Casual) Licking Memorial Health Systems

RN Case Manager - Case Management Licking Memorial Health Systems

RN Case Manager - Care Management (Days) FT Adena Health System

Behavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield Association

Utilization Review Coordinator Neuropsychiatric Hospitals

RN Case Manager, Care Management, Full Time, First Shift UC Health, LLC

RN Case Manager, Care Management, Full Time, First Shift UC Health

RN Case Manager, Clinical Case Management, Full Time, First Shift UC Health

RN - UNIT MANAGER Marion Valley MARIONVALLEY

RN Case Manager, PRN, First Shift UC Health, LLC

RN UM Discharge Planning SummaCare Inc

RN Care Manager - Exempt AcuteCare Health System LLC

RN Care Manager - Hourly- Per Diem AcuteCare Health System LLC

LPN Care Coordinator - Primary Care Kettering Health

RN WILLOUGHBY

Nurse Manager - FT 100% - M-F Days - ARMC Surgical Services Adena Health System

RN Case Manager, Emergency Department, Part Time, Second Shift, WOW UC Health

Nurse Supervisor State of Ohio

RN Care Manager TEEMA Group

RN Home Health TEEMA Group

Director of Clinical Services - RN - $10k Bonus CorsoCare

Registered Nurse Amivie Your Home Court Advantage LLC

HOME CARE - RN CASE MANAGER Aultman Alliance Community Hospital

Psychiatric Registered Nurse MTC

Nurse Care Manager I Elevance Health Inc

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