Care Review Nurse
Columbus, OH · On-site
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Columbus, OH · On-site
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Columbus, OH · On-site
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...
Cleveland, OH · On-site
Now Hiring: RN Utilization Review - Middleburg Heights, OH Are you a passionate RN professional ... Medical, Vision & Dental insurance * 401(k) Matching Program * Flexible Schedules * Travel ...
Cleveland, OH · On-site
Now Hiring: RN Utilization Review - Middleburg Heights, OH Are you a passionate RN professional ... Medical, Vision & Dental insurance * 401(k) Matching Program * Flexible Schedules * Travel ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ...
The Utilization Review Specialist is responsible for the authorizations and certifications process ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
The Utilization Review Specialist is responsible for the authorizations and certifications process ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ... Health Insurance * Dental Insurance * Vision Insurance * Safe Harbor and Retirement Savings Plan ...
Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ... Health Insurance * Dental Insurance * Vision Insurance * Safe Harbor and Retirement Savings Plan ...
... Utilization Review Coordinator for our team in Blue Ash OH! WHO WE ARE The New Vista mission ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
... Utilization Review Coordinator for our team in Blue Ash OH! WHO WE ARE The New Vista mission ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...
Utilization Review * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 weeks * 40 hours per ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...
Utilization Review * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 weeks * 40 hours per ... We offer dental insurance to you and your dependents. * Vision Coverage : Available the 1st of the ...
Cleveland, OH · On-site
$2.2K/wk
Anders Group is hiring a Travel Utilization Review Registered Nurse (RN) in Middleburg Heights, OH ... Medical, dental, and vision insurance * 401(k) retirement plan * Licensure reimbursement programs
Cleveland, OH · On-site
$2.2K/wk
Anders Group is hiring a Travel Utilization Review Registered Nurse (RN) in Middleburg Heights, OH ... Medical, dental, and vision insurance * 401(k) retirement plan * Licensure reimbursement programs
Beachwood, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Beachwood, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Brunswick, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Brunswick, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Brook Park, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Brook Park, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
$20.34 - $24.45
2% of jobs
$24.45 - $28.57
9% of jobs
$31.38 is the 25th percentile. Wages below this are outliers.
$28.57 - $32.68
21% of jobs
The median wage is $36.01 / hr.
$32.68 - $36.79
23% of jobs
$36.79 - $40.91
13% of jobs
$44.11 is the 75th percentile. Wages above this are outliers.
$40.91 - $45.02
10% of jobs
$45.02 - $49.13
8% of jobs
$49.13 - $53.25
5% of jobs
$53.25 - $57.36
5% of jobs
$57.36 - $61.48
2% of jobs
$61.48 - $65.59
2% of jobs
$20
$40
$65
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
The most popular types of Insurance Utilization Review jobs in Ohio are:
For Insurance Utilization Review jobs in Ohio, the most frequently searched job titles are:
The top searched job categories for Insurance Utilization Review jobs in Ohio are:
Cities in Ohio with the most Insurance Utilization Review job openings:

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Medicaid Division
Duties: Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses working at the facilities Members are being care for, will be sending over clinical information to be reviewed by the Care Review Clinician. Therefore, this agent will not be traveling and will be reviewing information at the office.
Qualifications: Background Hospital Utilization Management. Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok if they have more Utilization Review experience) Potential for longer term dependent on enrollment Workers will be doing Concurrent Inpatient Review MUST have one of the following AT LEAST -Utilization Review in hospital setting Nurses who are used to doing both production and review work
All your information will be kept confidential according to EEO guidelines.
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Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Recruiting and staffing services
51 - 200 Employees
Edison, NJ, US
1996