Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
Pre Access Specialist
Akron, OH · On-site +1
... case management, utilization review, and clinical teams to gather necessary information and ... Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
RN Care Manager PRN
Cleveland, OH · Remote
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
$41.20 - $62.17/hr
Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...
Acquisition Utilization Specialist
Cincinnati, OH · On-site +1
$77K - $101K/yr
PTO
... by project managers, program managers, upper management and stakeholders on all aspects of ... Reviews procurement documents for accuracy, adequacy, and completeness, and assists service line ...
Acquisition Utilization Specialist
Cincinnati, OH · On-site +1
$77K - $101K/yr
PTO
... by project managers, program managers, upper management and stakeholders on all aspects of ... Reviews procurement documents for accuracy, adequacy, and completeness, and assists service line ...
... 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 ...
Application Review Coordinator
Oxford, OH · On-site +1
... 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 ...
Application Review Coordinator
Oxford, OH · On-site +1
... 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 ...
Remote Care Management - CMA
New Hampshire, OH · Remote
Medical
Dental
Vision
Life
Retirement
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 ...
Remote Care Management - CMA
New Hampshire, OH · Remote
Medical
Dental
Vision
Life
Retirement
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 ...
Remote Care Management - CMA
Delaware, OH · Remote
Medical
Dental
Vision
Life
Retirement
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 ...
Remote Care Management - CMA
Delaware, OH · Remote
Medical
Dental
Vision
Life
Retirement
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 ...
Tax Manager / Senior Manager (Remote - Ohio)
OH · Remote
$150K - $220K/yr
Medical
Dental
Vision
Retirement
PTO
Review and prepare complex individual, partnership, S Corporation, C Corporation, fiduciary and ... Fully remote opportunity for Ohio-based professionals * Competitive compensation plus annual bonus
Quick apply
Tax Manager / Senior Manager (Remote - Ohio)
OH · Remote
$150K - $220K/yr
Medical
Dental
Vision
Retirement
PTO
Review and prepare complex individual, partnership, S Corporation, C Corporation, fiduciary and ... Fully remote opportunity for Ohio-based professionals * Competitive compensation plus annual bonus
Suitability Review Specialist
Delaware, OH · Remote
$73K - $122K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
Delaware, OH · Remote
$73K - $122K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
New Hampshire, OH · Remote
$73K - $122K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Suitability Review Specialist
New Hampshire, OH · Remote
$73K - $122K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...
Care Management Lead, (RN OR LSW) - Akron - Remote
Akron, OH · On-site +1
$68K - $84K/yr
Position Summary Reporting to the Manager, Care Management, the Care Management Lead (CML) is ... Drive effective utilization of established best practices and protocols across the team, ensuring ...
Care Management Lead, (RN OR LSW) - Akron - Remote
Akron, OH · On-site +1
$68K - $84K/yr
Position Summary Reporting to the Manager, Care Management, the Care Management Lead (CML) is ... Drive effective utilization of established best practices and protocols across the team, ensuring ...
Optometrist - Remote
Columbus, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Cleveland, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Cleveland, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Toledo, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
Columbus, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
Optometrist - Remote
New Carlisle, OH · On-site +1
Medical
Dental
Vision
Retirement
PTO
In addition, the Optometrist will also diagnose and treat visual problems and manage diseases ... Staying abreast of changing healthcare landscape and opportunities for utilization of technologies ...
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?
| Aspect | Remote Utilization Review Manager | Remote Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like URAC or AAPC, and management experience | Licensed Registered Nurse (RN) with utilization review certification often preferred |
| Work Environment | Oversees review teams, manages processes, and ensures compliance remotely | Performs case reviews, assesses medical necessity, and documents findings remotely |
| Employer & Industry Usage | Health 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 job categories do people searching Remote Utilization Review Manager jobs in Ohio look for?
The top searched job categories for Remote Utilization Review Manager jobs in Ohio 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:
Full-time
Re-posted 21 days ago
Akron Children's Hospital rating
7.4
Based on 97 frontline employees who took The Breakroom Quiz
347th of 1,060 rated hospitals
Job description
Full-time, 40 hours/week
11:30am-8:00pm
Fully Remote but Onsite in Mahoning Valley for 60 days training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
11:30am-8:00pm
Fully Remote but Onsite in Mahoning Valley for 60 days training
Summary:
Pre Access Specialist is responsible for performing functions to facilitate the patient's seamless movement through the Revenue Cycle process. This role ensures demographic and insurance requirements are current, supports reimbursement processes, and minimizes claim denials by verifying coverage and communicating details downstream accurately and efficiently.
Responsibilities:
1. Manage Epic work queues and reports for Pre-Access tasks; to make outbound calls or send communications to patients and/or responsibility parties to collect information to update Epic and/or share information within required timeframes, etc.
2. Register complete and accurate demographic, guarantor and financial information to create the patient's record in the system for billing purposes.
3. Verify patient insurance coverage and eligibility using electronic systems or payer portals or phone calls.
4. Process, triage and document incoming calls, voicemails, faxes, and/or emails per standard protocols in the appropriate system or tool.
5. Apply approved scripting for patient interactions and handle unique scenarios professionally.
6. Collaborate with Patient Access team members, clinical departments, case management, utilization review, and clinical teams to gather necessary information and expedite services when needed.
7. Escalate issues related to coverage, status, denials, delays or repeated trends to leadership for review.
8. Create and send estimates as needed or refer cases to Financial Counseling when potential for patient liability exists.
9. Meet departmental standards for productivity, quality, and timeliness.
10. Other Duties as assigned
Other information:
Technical Expertise
1. Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
2. Strong interpersonal communication skills to support families with empathy and clarity
3. Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred
4. Strong understanding of insurance types (Medicare, Medicaid, commercial, managed care)
5. Excellent communication, organizational, and time management skills
6. Ability to work independently in a fast-paced environment.
7. Familiarity with EHR systems (e.g., Epic, Cerner) and payer portals and guidelines (i.e. Medicaid, managed care, and commercial plans)
Education and Experience
1. High school diploma or equivalent required; associate degree or healthcare certification preferred.
2. Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; registration, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.
3. Pediatric healthcare access roles preferred.
4. Certification in healthcare access (e.g., CHAA or CMAA) preferred.
5. Experience in hospital admissions or emergency department settings preferred.
• Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.
Full Time
FTE: 1.000000
Status: Remote
What Akron Children's Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Akron Children's Hospital
Sourced by ZipRecruiter
Akron Children's Hospital has been caring for children since 1890, and our pediatric specialties are ranked among the nation's best by U.S. News & World Report. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we're making it easier for today's busy families to find the high-quality care they need. In 2020, our health care system provided more than 1.1 million patient encounters. We also operate neonatal and pediatric units in the hospitals of our regional health care partners. Every year, our Children's Home Care Group nurses provide thousands of in-home visits, and our School Health nurses manage clinic visits for students from preschool through high school. With our Quick Care Online virtual visits and Akron Children's Anywhere app, we're here for families whenever and wherever they need us. Learn more at akronchildrens.org.
Industry
Hospitals
Company size
5,001 - 10,000 Employees
Headquarters location
Akron, OH, US
Year founded
1890