Offer summary

Qualifications:

Bachelor's degree in Nursing or a related clinical field is preferred., At least two years of Care Management or Utilization Management experience is required., In-depth knowledge of payer rules, regulations, and utilization guidelines is necessary., Ability to interpret medical necessity guidelines and apply them appropriately..

Key responsibilities:

Assess inpatient and observation services for medical necessity using established guidelines.

Ensure compliance with CMS, payer requirements, and utilization management standards.

Maintain awareness of healthcare trends and regulatory guidelines.

Contribute to the hospital's Utilization Management Program Plan.

Job description

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Job Title:

Utilization Care Manager (RN)

Department:

University Hospital | Care Management Services

Scope/Position Summary
The Utilization Care Manager (UCM) contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to
determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS
guidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payer
rules, regulations and MCG guidelines. The UM CM maintains an awareness of State and National health care trends, TJC, CMS and third party payor
Utilization Management guidelines.

Minimum Qualifications
For Hire: Bachelor's degree in Nursing preferred, public health, allied health, or other clinically related field. Two years of Care Management
and/or Utilization Management experience required.

Additional Information:

Location:

Remote Location

Position Type:

Regular

Scheduled Hours:

Shift:

First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions.

The university is an equal opportunity employer, including veterans and disability.

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