Utilization Management Jobs in Hamilton, OH (NOW HIRING)

The Medical Concierge serves as a trusted clinical and service resource for Perennial Advantage of Ohio (PAO) members, families, facility teams, and clinical partners. This position helps coordinate member care needs, answer questions and concerns, monitor transitions of care, support required documentation, and ensure timely communication and follow-up across multiple Otterbein locations and care settings.

The Medical Concierge serves as a primary Otterbein representative and point of connection for PAO members and families, helping them navigate care and plan-related processes while promoting personalized service, compassionate communication, and high-quality care coordination.

This position requires strong clinical judgment, organization, follow-through, and the ability to build trusted relationships with members, families, facility teams, Nurse Practitioners, and other interdisciplinary partners.

This position will be required to travel up to 50% to Otterbein locations, assisted living settings, nursing homes, meetings, and other care-related locations. Lodging will be provided when business travel requires more than a one-hour commute from the partner's home.

• Serve as a primary Otterbein representative and point of connection for Perennial Advantage of Ohio members and families.
  • Assist members and families with care needs, questions, concerns, service navigation, and plan-related processes.
• Conduct regular member visits, as appropriate.
  • Build relationships with members and families.
  • Identify needs and promote timely follow-up.
  • Help members and families understand next steps and available resources.
• Regularly review nurse notes, clinical updates, and care plans for Perennial Advantage members.
  • Communicate concerns, follow-up needs, admissions, discharges, transitions, and significant status changes to Nurse Practitioners and appropriate clinical leaders.
• Monitor for potential Skill in Place (SIP) episodes, Part A skilling episodes, transitions of care, and other situations requiring coordinated follow-up.
  • Work with facility teams, Nurse Practitioners, and Utilization Management to ensure appropriate follow-up.
• Support facility teams and Nurse Practitioners in ensuring required clinical information is submitted timely and accurately to the Perennial Advantage Utilization Management department.
• Document member visits, hospitalizations, returns from the hospital, significant updates, and follow-up actions in the appropriate electronic medical record.
• Maintain accurate records related to:
  • Health Risk Assessments
  • Care plans
  • Referrals
  • Authorizations
  • Permission to Contact forms
  • Other member-specific care coordination activities
• Review orders and submit appropriate referral requests.
• Gather required clinical documentation for referrals, procedures, and authorization requests.
• Monitor authorization approvals and communicate updates to facility staff, Nurse Practitioners, and other care team members.
• Complete Health Risk Assessments (HRAs) annually and with new enrollments in accordance with plan expectations.
• Create, review, and update member care plans in partnership with:
  • Nurse Practitioners
  • Facility teams
  • Members
  • Families
• Attend and support care conferences, plan-of-care meetings, and interdisciplinary calls.
  • Document applicable updates in the electronic medical record.
• Coordinate plan-of-care meetings for assisted living members in accordance with plan and operational expectations.
  • Ensure the member, family, facility staff, and Nurse Practitioner are informed and involved as appropriate.
• Communicate clearly and professionally with members, families, Nurse Practitioners, facility leaders, Home Office partners, plan representatives, Utilization Management, and interdisciplinary care team members regarding:
  • Member needs
  • Transitions of care
  • Authorizations
  • Membership changes
  • Follow-up needs
• Demonstrate strong clinical judgment and recognize concerns requiring timely follow-up or escalation.
• Maintain confidentiality, professionalism, accountability, and strong follow-through when managing member needs and clinical information.
• Work independently while remaining connected to clinical leadership, plan expectations, and facility operations.
• Remain flexible and responsive to changing member needs, travel expectations, and operational priorities.

• Licensure/Certification:
  • Current Ohio RN or LPN license required.
• Experience:
  • Minimum of five years of experience in a long-term care or nursing home environment required.
  • Experience in post-acute care, managed care, case management, utilization management, or care coordination strongly preferred.
  • Experience using electronic medical record systems required.
  • PointClickCare experience preferred.
  • Ability to work effectively within multiple electronic medical record systems, portals, and documentation platforms.
  • Working knowledge of Microsoft Outlook, Excel, and other standard business tools.
  • Strong understanding of long-term care operations, resident-centered care, clinical documentation, care planning, and interdisciplinary communication.
• Skills & Characteristics:
  • Strong clinical judgment and ability to recognize concerns that require timely follow-up or escalation.
  • Highly organized and detail-oriented.
  • Ability to manage multiple member needs, documentation requirements, and follow-up items across locations.
  • Strong written and verbal communication skills.
  • Ability to communicate compassionately and build trusted relationships with members, families, facility teams, Nurse Practitioners, and interdisciplinary partners.
  • Comfortable navigating clinical systems, electronic records, authorization processes, and plan-related workflows.
  • Strong follow-through, confidentiality, professionalism, and accountability.
  • Ability to work independently while maintaining communication with clinical leadership and facility teams.
  • Flexible and responsive to changing operational priorities and member needs.
  • Service-oriented mindset with a commitment to quality, clarity, and continuous improvement.

Why work for Otterbein SeniorLife:

For more than 100 years, Otterbein has provided senior housing options rooted in respect and community.  We're a non-profit 501(c)(3) health and human service organization, so our values and initiatives are focused on serving our residents.

Otterbein SeniorLife consists of lifestyle communities, revolutionary small house neighborhoods, home health, and hospice care in Ohio and Indiana.  We offer different lifestyle options for seniors through independent living, assisted living, skilled nursing, rehab, memory support, respite care, in-home care, and hospice services.