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Remote Utilization Management Jobs in Ohio (NOW HIRING)

CareSource

Pharmacist I

Dayton, OH · Remote

$94K - $164K/yr

Formulary Management guidelines, Utilization Management programs, CareSource Administrative and ... General office or Remote work environment; may be required to sit or stand for extended periods of ...

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Remote Utilization Management information

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Ohio? The most popular types of Utilization Management jobs in Ohio are:
What are popular job titles related to Remote Utilization Management jobs in Ohio? For Remote Utilization Management jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Ohio look for? The top searched job categories for Remote Utilization Management jobs in Ohio are:
What cities in Ohio are hiring for Remote Utilization Management jobs? Cities in Ohio with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Ohio as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

RN Field Behavioral Health Case Manager

Healthcare Support Staffing

Maumee, OH • Remote

Full-time

Re-posted 13 days ago

Job description

Company Description

Are you an experienced Administrative Assistant looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!

Job Description

RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. RN Field Behavioral Health Case Manager assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the High Risk Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members. 

Daily Responsibilities: 

RN Field Behavioral Health Case Manager will be responsible for the Lucas County patient members'

Work telephonically with patients identified as high risk to identify needs, set goals and implement action steps towards achieving goals. 

Empower patients to help them improve their quality of life. 

Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.

RN Field Behavioral Health Case Manager participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.

RN Field Behavioral Health Case Manager will assist with the implementation of policies and procedures regarding case management and utilization management functions.

Working with these members to identify needs and goals to achieve improved quality of life.

Maintain HIPAA compliance.


Qualifications

Requirements: 

MUST have a valid RN License in the State of OH

3 years of Behavioral Health experience 

3-5 years of case and/or utilization management experience.

CCM (Certified Case Manager) or other clinical certification preferred

Hours for this Position: 

Monday - Friday 8 am - 5 pm.   


Advantages of this Opportunity:

Competitive salary

Growing Company

Medical benefits go into effect 30 days after start date



Additional Information


If you are interested in applying to this position, please contact Shanna Ramirez, (407) 636-7030 ext. 170 and click the Green "I'm Interested" Button to email your resume.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!


The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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