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Utilization Case Manager Jobs in Ohio (NOW HIRING)

Premier Health

CASE MANAGER

Middletown, OH · On-site

$19 - $24.50/hr

Promotes care coordination and effective utilization of resources through the assessment of patient ... Certification in area of clinical specialty (Case Management, Neuro, Critical Care, Rehab or ...

Premier Health

CASE MANAGER

Middletown, OH · On-site

$19 - $24.50/hr

Promotes care coordination and effective utilization of resources through the assessment of patient ... Certification in area of clinical specialty (Case Management, Neuro, Critical Care, Rehab or ...

Premier Health

CASE MANAGER

Middletown, OH · On-site

$19 - $24.50/hr

Promotes care coordination and effective utilization of resources through the assessment of patient ... Certification in area of clinical specialty (Case Management, Neuro, Critical Care, Rehab or ...

Premier Health

CASE MANAGER

Middletown, OH · On-site

$19 - $24.50/hr

Promotes care coordination and effective utilization of resources through the assessment of patient ... Certification in area of clinical specialty (Case Management, Neuro, Critical Care, Rehab or ...

Holzer Health System

Lead Case Manager

Gallipolis, OH · On-site

Serves as a clinical expert and resource in Utilization Review and Case Management. Refers ... potential candidates for early discharge planning to Social Work, Hospice, Home Health or Rehab as ...

Holzer Health System

Lead Case Manager

Gallipolis, OH · On-site

Serves as a clinical expert and resource in Utilization Review and Case Management. Refers ... potential candidates for early discharge planning to Social Work, Hospice, Home Health or Rehab as ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Promotes care coordination and effective utilization of resources through the assessment of patient ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Promotes care coordination and effective utilization of resources through the assessment of patient ...

Premier Health

CASE MANAGER

Dayton, OH · On-site

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Promotes care coordination and effective utilization of resources through the assessment of patient ...

Premier Health

CASE MANAGER

Dayton, OH

$19.50 - $25/hr

Miami Valley Hospital The Case Manager is a registered nurse responsible for individualized patient ... Promotes care coordination and effective utilization of resources through the assessment of patient ...

Encompass Health

Case Manager

Dayton, OH

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Phoenix Group Home, LLC

Case Manager

Hamilton, OH · On-site

$18.75 - $24/hr

Case Manager TITLE: Case Manager, Behavioral Health RESPONSIBLE TO: Regional Leadership WORK AREA ... Identify and address gaps in service, as well as monitor under and over-utilization of authorized ...

Encompass Health Corporation

Case Manager

Westerville, OH · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...

Encompass Health

Case Manager

Westerville, OH

$19.25 - $24.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Ohio

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

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

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Ohio? For Utilization Case Manager jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Ohio look for? The top searched job categories for Utilization Case Manager jobs in Ohio are:
What cities in Ohio are hiring for Utilization Case Manager jobs? Cities in Ohio with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Ohio as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Full Time 40 hours week Exempt RN Case Manager

Wooster Community Hospital

Wooster, OH • On-site

$32.12 - $50.06/hr

Full-time

Re-posted 11 days ago

Wooster Community Hospital rating

6.9

Company rating: 6.9 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

551st of 1,056 rated hospitals

Job description

RN Case Manager (40hrs/week)


MAIN FUNCTION:

Supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care.

RESPONSIBLE TO: Manager, Care Management

MUST HAVE REQUIREMENTS:

  • Active unrestricted Ohio RN license
  • Bachelor's Degree
  • Acute care nursing and/or case management experience


COMPLEXITY OF WORK:

Requires critical thinking skills, decisive judgment and ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

PREFERRED ATTRIBUTES:

  • Critical care experience
  • Knowledge of discharge processes and resource utilization.
  • Case management experience in an acute care setting
  • Certification in Case Management through ACMA
  • 5-years of experience in an acute care setting
  • Prior case management experience strongly preferred


POSITION EXPECTATIONS:

  • Performs all aspects of Case Management, including care coordination, discharge planning and resource management.
  • Determines appropriate level of care based on the intensity of effort required to diagnose, treat, preserve or maintain the patient’s physical or emotional state.
  • Verifies that all inappropriate admissions, unnecessary continued days, and procedures not meeting approved indications are reviewed and discussed with the attending physician.
  • Identifies delays in care or services and reports the findings to the appropriate department manager or attending physician.
  • Interviews patients, patient representatives, and/or patients’ family/friends when appropriate; meets their psychosocial needs within the scope of authority and established procedures and protocols.
  • Collaborates with patient/patient representative, patient caregiver, social worker, and multidisciplinary team to determine discharge plan for patients.
  • Participates in multidisciplinary rounds working with the team to organize, secure, integrate and modify the resources necessary to ensure the patient is getting the right treatment in the right place at the right time.
  • Participates in daily huddles to review LOS concerns, contributing knowledgeable to the discussion and enacting follow up recommendations
  • Communicates with medical staff, hospital personnel, and post-acute providers to provide continuum of care to all patients.
  • Initiates the discharge plan for patients of all ages and coordinates and arranges services needed by the patient post-discharge in collaboration with the discharge planning assistant.
  • Regularly evaluates the need for continued hospitalization and for necessary changes in the discharge plan with subsequent documentation of such.
  • Makes recommendations for changes in the department’s policies, procedures and protocols.
  • Anticipates and reports potential problems to appropriate personnel.
  • Monitors appropriateness of admissions and continued stay to specialty areas (Telemetry, ICU).
  • Ensures completion of daily work assignments by prioritizing and reassigning duties.




Monday through Friday; weekend rotation requirement
0800-1630; 40 hours/week

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