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Remote Utilization Review Manager Jobs in Ohio (NOW HIRING)

Formerra

Account Manager

Toledo, OH · Remote

... utilization of customer centric selling skills and tools, such as use of scorecards, business ... Remote: Ability to work independently in a fully remote environment with minimal supervision ...

Medpace

Clinical Data Coder

Cincinnati, OH · On-site +1

$18 - $22.75/hr

Work collaboratively with the Medical, Data Management, Safety and Biostatistics teams to meet needs of the study; and * Produce coding reports for team review and utilization *Stable schedule with ...

Medpace

Clinical Data Coder

Cincinnati, OH · On-site +1

$18 - $22.75/hr

Work collaboratively with the Medical, Data Management, Safety and Biostatistics teams to meet needs of the study; and * Produce coding reports for team review and utilization *Stable schedule with ...

Medpace, Inc.

Clinical Data Coder

Cincinnati, OH · On-site +1

$18 - $22.75/hr

Work collaboratively with the Medical, Data Management, Safety and Biostatistics teams to meet needs of the study; and * Produce coding reports for team review and utilization *Stable schedule with ...

Huntington

Credit Review Officer - Consumer

Cleveland, OH · On-site +1

$70K - $140K/yr

The Credit Review Officer - Consumer reports to a Credit Review Group Manager or Team Lead. The ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

Huntington

Credit Review Officer - Consumer

Cleveland, OH · On-site +1

$70K - $140K/yr

The Credit Review Officer - Consumer reports to a Credit Review Group Manager or Team Lead. The ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

Huntington

Credit Review Officer - Consumer

Columbus, OH · On-site +1

$70K - $140K/yr

The Credit Review Officer - Consumer reports to a Credit Review Group Manager or Team Lead. The ... Remote roles will also have the opportunity to come together in our offices for moments that matter.

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

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 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

REMOTE SUPPORT PROGRAM MANAGER

Dayton, OH • On-site, Remote

Choices In Community Living
Non-Profits • 201 - 500 employees
Learn more about Choices In Community Livingexternal

Full-time

Re-posted 20 days ago

Job description

JOB SUMMARY:
The Remote Supports Program Manager, under the guidance of the Program Director, oversees the delivery of remote services and support for individuals in a residential setting. This role ensures program quality, compliance, and the development of Remote Support Professionals (RSPs).
RESPONSIBILITIES AND MAJOR DUTIES:
Client Services & Program Implementation:
  • Deliver high-quality remote support services (RSS) as assigned.
  • Manage all aspects of service implementation in accordance with Individual Service Plans (ISPs), ensuring compliance with Ohio Department of Developmental Disabilities (ODDD) regulations.
  • Creation/ updating individual hardware and software plans.
  • Coordinate and utilize various resources to meet client needs, reflecting them in the ISP.
  • Schedule staffing for open shifts and provide direct coverage when needed.
  • Maintain confidentiality and update sensitive information as required.

Staff & Program Management:
  • Provide supervision, support, and training for RSPs.
  • Conduct staff meetings, oversee documentation, and ensure compliance with agency policies.
  • Maintain and update program documentation, including training materials
  • Oversee Quality Assurance (QA), audits, and program reviews while managing reporting and documentation processes.

Client Support & Home Management:
  • Build and maintain strong relationships with clients, SSA staff, coworkers, and other stakeholders as appropriate.

Administrative & Fiscal Responsibilities:
  • Supervise and document employee performance, ensuring compliance with agency standards.
  • Serve as the primary point of contact for staff or client concerns, escalating issues as needed.
  • Coordinate installation and troubleshooting of remote equipment.

Availability & Compliance:
  • Respond to emails and phone calls promptly, including after-hours availability as required.
  • Work approximately 30 RSP third -shift hours per week.
  • Ensure compliance with agency personnel policies, operational procedures, and regulatory standards.
  • Adapt to evolving duties and responsibilities as assigned.

POSITION QUALIFICATIONS:
Education:
  • High school diploma or GED equivalent required.
  • Background in technology preferred.
  • Strong reading, writing, and oral communication skills.
  • Basic math skills and computer literacy.

Experience:
  • Background in social services, healthcare, technology or management preferred.

Physical Requirements:
  • Ability to engage in physical activities such as lifting (minimum of 30 lbs.), standing, walking, bending, and reaching.

Other Requirements:
  • Valid driver's license with an insured and good driving record (4 points or less).
  • Some travel to satellite offices and residential sites.

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