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Utilization Case Manager Jobs in Ohio (NOW HIRING)

Select Medical

Hospital Case Manager

Cleveland, OH

$40/hr

... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...

LMHS

RN Case Manager - Case Management

Newark, OH · On-site

RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...

LMHS

RN Case Manager - Case Management

Newark, OH · On-site

RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...

Pinnacle Treatment Centers

Case Manager

Cincinnati, OH · On-site

$19.25 - $24.75/hr

Case Manager M-F 6a-2:30p and possible Saturdays 6a-10a We offer competitive salary, full benefits ... utilization of resources, service delivery, and compliance with external agencies and referral ...

Sheakley

RN Case Manager

Columbus, OH · On-site

Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Case Management Team Lead * Assess documentation of medical records for completeness on a ...

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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.

RN Case Manager - Case Management

Licking Memorial Health Systems

Newark, OH • On-site

Full-time

Re-posted 14 days ago

Job description

RN Case Manager

Position Summary

The case manager is responsible for individualized management of hospital and healthcare services necessary and appropriate to the provision of high quality, cost effective patient care. He or she works with acutely ill and/or high risk clients ranging in age from newborn to the geriatric population. The Case Manager develops collaborative, outcome-oriented plans of care for each patient, acts as a patient advocate and provides mechanisms and support to empower patients to make responsible healthcare decisions while guiding appropriate utilization of resources and services to achieve expected outcomes.

Responsibilities

    • Determines appropriate level of care on admission using hospital approved medical necessity criteria
    • Performs patient and care giver assessments to identify pertinent problems/needs
    • Organizes assessment data into an individual plan of care, with anticipated outcomes
    • Determines continued stay status
    • Participates in multidisciplinary rounds
    • Participates in patient education
    • Tracks and manages potential avoidable hospital days
    • Provides clinical information to external providers and managed care organizations
    • Assists in discharge planning
    • Assists in appeals and denials management

Requirements

    • Graduate of an accredited school of nursing and licensed in the state of Ohio
    • 2 years of clinical experience in an acute care setting
    • Critical care/emergency department experience highly desired
    • Knowledge of evidenced-based practice and disease management protocols
    • Utilization review and or discharge planning experience preferred
    • Excellent verbal and written communication skills
    • Excellent computer skills.
    • LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, color, religion, sex, sexual orientation, age, ancestry, national origin, veteran status, pregnancy, disability, marital status, or other characteristics protected by law.

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