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Remote Utilization Review Manager Jobs in Ohio (NOW HIRING)

Manulife

Suitability Review Specialist

Delaware, OH · Remote

$73K - $122K/yr

Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...

Manulife

Suitability Review Specialist

New Hampshire, OH · Remote

$73K - $122K/yr

Experience in suitability review, compliance, risk management, or a related financial services ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Ohio

Remote Utilization Review Manager information

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 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 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:
Remote Utilization Review Manager jobs near you

Optometrist - Remote

Health Partners of Western Ohio

New Carlisle, OH • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 18 days ago

Job description

Optometrist (Remote) - School Based Outreach
This is a full-time position following the assigned school districts school year and paid all year round.
(Monday through Friday 7:30am - 4:00pm)
The school year includes all working days for teachers, including remote work days, and is subject to potential modifications throughout the school year.
POSITION PURPOSE
The Optometrist is primarily responsible for examining the eyes and other parts of the visual system. In addition, the Optometrist will also diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes. The Optometrist will also prescribe eyeglasses or contact lenses as needed. The Optometrist will promote eye health and counsel patients on how general health can affect eyesight. Position can be located remote or hybrid.
QUALIFICATIONS
EDUCATION/CERTIFICATION: Must complete a Doctor of Optometry (O.D.) degree program from an accredited optometry school and complete all sections of the National Board of Examiners in Optometry exam. Current license to practice as a Doctor of Optometry (O.D.).
REQUIRED KNOWLEDGE: Successful completion of in-house training.
EXPERIENCE REQUIRED: Minimum of 5 years as a practicing Doctor of Optometry (O.D).
BENEFITS:
  • Paid Time Off (PTO)
  • Insurance (Medical, Dental, and Vision)
  • Paid Holidays
  • 403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
  • Eligible to Apply for National Health Service Corps Loan Repayment
  • Continuing Education Money ($3,000) that can be used for license, DEA, memberships, CE classes and travel expenses.
  • Annual Raises
  • Training Opportunities
ESSENTIAL FUNCTIONS AND BASIC DUTIES:
  • Assist with establishing vision policies, quality improvement procedures, and evaluating current practices, policies, and procedures.
  • Staying abreast of changing healthcare landscape and opportunities for utilization of technologies to support the enhanced provision of vision services for patients.
  • Maintain supervision and communication with optical and support staff to optimize quality clinical care and services.
  • Provides leadership in developing the vision care plan and review of the program requirements; and recommends changes when necessary to carry out the vision plan as required.
  • Assist the Clinical Director in designing, implementing, and evaluating educational programs for the Health Partners of Western Ohio patients and vision staff.
  • Assume quality care for all patients.
  • Complete patient history and conduct eye examinations using optometric equipment and general diagnostic interpretation.
  • Diagnose sight problems, such as nearsightedness or farsightedness, and eye diseases, such as glaucoma.
  • Prescribe eyeglasses, contact lenses, and other visual aids, and if state law permits, medications.
  • Provide treatments such as vision therapy or low-vision rehabilitation.
  • Evaluate patients for the presence of other diseases and conditions, such as diabetes or hypertension, and refer patients to other healthcare providers as needed.
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Utilize supplies cost-effectively while ensuring that the vision department stays within budget.
  • Participate in continuing education and professional growth.
  • Maintain knowledge of, and complies with, personnel and Vision policies and procedures.
  • Adhere to the standards and policies of the Organizational Privacy/ Security and Compliance Programs, including the duty to comply with applicable laws and regulations (HIPAA, OSHA, OIG guidelines, and other State and Federal laws).
  • Promote eye and general health by counseling patients.
  • Analyze test results and develop a treatment plan.
  • Adhere to the highest standards of vision practice, ethics, and professionalism.
  • Recommend changes in all vision areas, and/or general areas to improve the patient flow, medical records, billing practices, and appointment practices.
  • Document all patient care provided according to policy.
  • Formulate and direct a plan of care for the patient.
  • Refer to physicians or specialists, as needed.
  • Respond to vision emergencies.
  • Other duties as required by the funding agencies to carry out contractual agreements and/or as established by the Health Partners of Western Ohio, Management and Board of Directors.
  • Must become familiar with the Federal and State rules, regulations, and practices in a Community Health Center.
  • Become familiar with Federal and State Health care program requirements and assist in carrying out these programs.
  • Assist in developing the vision care plan and review of the program requirements; and recommend changes when necessary to carry out the vision plan as required.
  • Adhere to the Health Partners of Western Ohio Integrated Health Care Philosophy.
  • Participate in Performance Improvement/Risk Management Program.
  • Provide services in office and throughout community in an outreach manner.
  • May be responsible for driving HPWO vehicle to provide services.
  • Employee is to follow all policies and procedures regarding company vehicle.
  • The position is responsible for other duties as assigned.
WORK ENVIRONMENT
Work is primarily sedentary, demanding sitting, walking, lifting, and bending. Those physical movements and the degree of mobility, manual dexterity, and hand-eye coordination commonly associated with duties in an office setting will be performed repetitively. This also includes bending, twisting, reaching, lifting, pulling, pushing, and walking. The ability to distinguish letters and symbols and utilize telephones, computer terminals, fax machines, and copiers is required. The work environment characteristics described here represent those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. Working under stressful conditions, as well as irregular hours, may be required.

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