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Remote Utilization Review Manager Jobs in Ohio (NOW HIRING)

Clinical Director

Cincinnati, OH ยท On-site +1

$76K - $104K/yr

Coordinate and collaborate with the contracted billing company and any internal utilization review ... Comfort working in a remote/field-hybrid role with independent time management Competencies

Credit Review Team Leader Sr

Columbus, OH ยท On-site +1

$125K - $255K/yr

The Credit Review Team Leader Sr. has a proven track record in a Credit Review management role or ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

Outpatient Coding Consultant - Remote

Toledo, OH ยท Remote

$18.50 - $23.25/hr

Review medical records and assign accurate codes for diagnoses and procedures. * Assign and ... Communicate with co-workers, management, and hospital staff regarding clinical and reimbursement ...

... manage key aspects of the domestic application review process, including training Miami's AI ... Remote work is not a right, but a working arrangement that can be modified or revoked by Miami ...

... manage key aspects of the domestic application review process, including training Miami's AI ... Remote work is not a right, but a working arrangement that can be modified or revoked by Miami ...

Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Our program offers a customized model of remote care services that blends Chronic Care Management ...

Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Our program offers a customized model of remote care services that blends Chronic Care Management ...

Review and prepare complex individual, partnership, S Corporation, C Corporation, fiduciary and ... Fully remote opportunity for Ohio-based professionals * Competitive compensation plus annual bonus

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Remote Utilization Review Manager information

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are the most commonly searched types of Remote Utilization Review jobs in Ohio?

The most popular types of Remote Utilization Review jobs in Ohio are:

What are popular job titles related to Remote Utilization Review Manager jobs in Ohio?

For Remote Utilization Review Manager jobs in Ohio, the most frequently searched job titles are:

What cities in Ohio are hiring for Remote Utilization Review Manager jobs?

Cities in Ohio with the most Remote Utilization Review Manager job openings:

Seasonal Honors Reviewer Manager

Columbus, OH โ€ข On-site, Remote

The Ohio State University
Scientific Research and Development Servicesย โ€ขย 51 - 200 employees

$17.50/hr

Part-time

Posted 9 days ago


Job description

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions.
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Job Title:
Seasonal Honors Reviewer Manager
Department:
Strategic Enrollment | Undergraduate Admissions
The Honors Application Reviewer Manager position in Undergraduate Admissions within Strategic Enrollment Management provides a holistic evaluation source for domestic and international applications for acceptance into the Honors Program at The Ohio State University. The Honors Application Reviewer Manager provides supervision to ten (10) seasonal honors application reviewers. The seasonal honors application review manager is responsible for planning trainings and meetings, assisting with application assignment, providing feedback, and coaching to reviewers and resolving concerns from reviewers. Develops a thorough understanding of Ohio State's Honors Program enrollment goals, policies and procedures and completes holistic review and evaluation of application credentials. In addition to supervising reviewers, this position reads, reviews, and evaluates applications. Required to enter recommendations for completed reviews into the review site on a weekly basis. This review is based on extensive training, written guidelines, and best practices set forth by Strategic Enrollment Management, Undergraduate Admissions, and the University Honors and Scholar Center.
Files are assigned weekly via an online secure review site. Once completed, recommendations are submitted electronically, and new files are assigned for the following week. Assist with the execution of mandatory monthly training, and other meetings as needed during normal university business hours. Works with the assistant director of application review to employ a comprehensive process of setting expectations of seasonal reviewers through role planning, coaching, assignment and review. The seasonal honors application reviewer manager has the responsibility to remain up to date with procedural and guideline changes which might affect the review process provided by Undergraduate Admissions.
Opportunities for professional development during the review season will be offered. Throughout the review process, reviewers must ensure confidentiality and security of admission files and university materials. Requires a flexible work schedule averaging 14-18 hours per week with some weeks during January and February requiring up to 20 hours. Reviewers will conduct a holistic review on an average of 80 files a week with some weeks during January and February requiring additional files. Reviewers are compensated at an hourly rate. Candidates must commit to completing the needed files per week and attending all virtual required trainings and meetings. Reviewers will use University issued equipment.
This is a seasonal position which begins in mid-November and ends in mid-March.
Qualifications
Required:
Bachelor's degree, preferably in counseling, human relations, or education. Reasonable knowledge of high school guidance or teaching. Familiarity and knowledge with college/university policies and procedures, recruitment or admissions, or counseling practices at higher education institutions.
This position requires successful completion of a background check.
Desired:
Previous application reviewing experience. Supervisory experience. 1 -2 years of relevant experience.
Additional Information:
The targeted pay rate range for this position is $17.50 - $ 22.86/hr. The offer for this position will fall within this range based on internal equity, units' available budget, and the candidates' qualifications.
This is a remote position with occasional opportunities to come in-person to the Columbus campus.
An OSU staff member may have multiple positions provided the sum-total of the positions does not exceed 100% full-time equivalency (FTE) and the position combination is consistent with the following principles:
  • A combination of exempt and non-exempt positions is not permitted.
  • A combination of staff and student employment positions is not permitted.
  • Classified positions may be combined only with other classified positions of the same exempt or nonexempt status.

Seasonal Honors Reviewer Manager candidates must be Ohio residents and live in the state of Ohio while serving in the role.
Essential Duties
80%: Provides a holistic evaluation source for domestic and international applications for acceptance into the Honors Program at The Ohio State University. Provides supervision to 10 seasonal honors application reviewers. The seasonal honors application review manager is responsible for planning trainings and meetings, providing feedback, and coaching to reviewers and resolving concerns from reviewers. Develops a thorough understanding of Ohio State's Honors Program enrollment goals, policies and procedures and completes holistic review and evaluation of application credentials. Reads, reviews, and evaluates applications. Required to enter recommendations for completed reviews into the review site on a weekly basis.
20%: Assist with the execution of mandatory monthly trainings, and other meetings as needed during normal university business hours. Works with the assistant director of application review to employ a comprehensive process of setting expectations of seasonal reviewers through role planning, coaching, assignment and review. The seasonal honors application reviewer manager has the responsibility to remain up to date with procedural and guideline changes which might affect the review process provided by Undergraduate Admissions. Opportunities for professional development during the review season will be offered. Throughout the review process, reviewers must ensure confidentiality and security of admission files and university materials.
Location:
Remote Location
Position Type:
Seasonal (Seasonal)
Scheduled Hours:
20
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.