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Utilization Review Case Manager Jobs in Ohio (NOW HIRING)

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

Previous Care Management, Case Management, or Utilization Management Experience. * Experience with doing 30+ reviews a day. * Previous experience with screening criteria including Cerner, InterQual ...

Nationwide Children's Hospital

Conducts utilization reviews of behavioral health cases to determine medical necessity ... management to maintain appropriate and cost-effective patient care. * Documents all case reviews ...

Lifepoint Health

Specialist, Utilization Review

Columbus, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH

Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG ...

Southwest General

UTILIZATION SPECIALIST

Brunswick, OH · On-site

Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization Management Experience preferred * Previous experience with screening criteria (i.e. Interqual, MCG ...

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

Utilization Review Case Manager information

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$15

$34

$57

How much do utilization review case manager jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for utilization review case manager in Ohio is $34.69, according to ZipRecruiter salary data. Most workers in this role earn between $28.12 and $36.59 per hour, depending on experience, location, and employer.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

What are popular job titles related to Utilization Review Case Manager jobs in Ohio?

For Utilization Review Case Manager jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Ohio look for?

The top searched job categories for Utilization Review Case Manager jobs in Ohio are:

What cities in Ohio are hiring for Utilization Review Case Manager jobs?

Cities in Ohio with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 10% Part Time, and 4% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $72,149 per year, or $34.7 per hour.

Manager- Utilization Management

MetroHealth

Cleveland, OH • On-site

Full-time

Posted 16 days ago

Job description

Location: METROHEALTH MEDICAL CENTER
Biweekly Hours: 80.00
Shift: 7a-330p
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application of clinical criteria to ensure medical necessity, correct patient status and level of care. Works with payors and providers to establish and maintain processes that ensure accurate and timely utilization review that is consistent with contractual agreements. Collaborates with MH Admissions and Financial Clearance department to develop and revise processes to meet regulatory and payor requirements. Serves as a clinical resource to the physician group and Utilization Review team and support staff and management. Upholds the standards of the system-wide customer service program.
Qualifications:
Registered Nurse with valid Ohio licensure. Bachelor's Degree in Nursing. Four years equivalent work experience in utilization review/case management may be considered in lieu of degree. Five years experience in case management to include experience with medical necessity criteria, such as Inter Qual and MCG. Strong analytical and trouble shooting skills. Strong communication skills. Strong computer skills including excel and word. Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds. Preferred: EPIC experience. Master's degree in related field. Supervisory experience. Physical Requirements: May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods. See in the normal visual range with or without correction. Hear in the normal audio range with or without correction. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Ability to use computer. Ability to communicate in face-to-face, phone, email, and other communications. Ability to read job-related documents.

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