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Utilization Management Jobs in Ohio (NOW HIRING)

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patient's plan of care. The Utilization Specialist's responsibility is to collect data and ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patient's plan of care. The Utilization Specialist's responsibility is to collect data and ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patient's plan of care. The Utilization Specialist's responsibility is to collect data and ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patient's plan of care. The Utilization Specialist's responsibility is to collect data and ...

Integrated Resources

Care Review Nurse

Columbus, OH · On-site

Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...

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All JobsUtilization Management JobsUtilization Management Jobs in Ohio

Utilization Management information

See Ohio salary details

$37.1K

$85.1K

$155K

How much do utilization management jobs pay per year?

As of Sep 15, 2026, the average yearly pay for utilization management in Ohio is $85,071.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,300.00 and $99,300.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Ohio?

The most popular types of Utilization Management jobs in Ohio are:

What are popular job titles related to Utilization Management jobs in Ohio?

For Utilization Management jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Ohio look for?

The top searched job categories for Utilization Management jobs in Ohio are:

What cities in Ohio are hiring for Utilization Management jobs?

Cities in Ohio with the most Utilization Management job openings:

Infographic showing various Utilization Management job openings in Ohio as of September 2026, with employment types broken down into 96% Full Time, and 4% Part Time. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $85,071 per year, or $40.9 per hour.

RN Utilization Rvw Spclst - Utilization Management

Miamisburg, OH • On-site

Kettering Health
See more jobs at Kettering Healthexternal

Part-time

Re-posted 4 days ago

Kettering Health rating

7.2

Company rating: 7.2 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

Job description

Incentives

Utilization Management | Miamisburg | Part-time | Varied Shift

Overview

Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Preferred Qualifications
  • 5 years clinical experience with 2 years case management
  • Case Management certification
  • Works independently
  • Familiar with MCG Care guidelines
  • Ability to adapt quickly to changing priorities and regulations
  • Experience with Microsoft applications and EPIC software

                                                                            ! WEEKEND ONLY!

Responsibilities & Requirements
  • Registered professional nurse with education, knowledge and experience.
  • Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status.  
  • Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.
  • Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.
  • Identifies potential or actual denials for admission or ongoing stay both during the patient's hospital stay and post discharge.
  • Review and decide the validity of medical necessity payer denials.  Submits payer denial appeals.
  • Participates in design of work flows and procedure to reduce incidence of denials.
  • Current unrestricted Ohio RN licensure, BSN required.
  • Experience with computers required.
Employment Type: PART_TIME

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