ZipRecruiter

Log In

1

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 ...

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:

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 ...

next page

Showing results 1-20

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

Utilization Review Case Manager information

See Ohio salary details

$15

$34

$57

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

As of Aug 12, 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.

Travel Nurse RN - Utilization Review

Encode INC

Middleburg Heights, OH • On-site

$65/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 14 days ago

Job description

Encode INC is seeking a travel nurse RN Utilization Review for a travel nursing job in Middleburg Heights, Ohio.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 08/24/2026
  • Duration: 12 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

Urgent Hiring – Utilization Management (UM) Registered Nurse
 

Location: Southwest General Health Center – Middleburg Heights, OH
Position: Utilization Management (UM) RN / Utilization Specialist
Schedule: Full-Time | 40 Hours/Week | Monday–Friday | 8:00 AM – 4:30 PM + Every 3rd Weekend
Pay Rate: $65 per hour and $2600 per week.
 

Position Overview:
 

We are actively seeking an experienced Utilization Management Registered Nurse (UM RN) to join the team at Southwest General Health Center. This is an on-site opportunity for a highly skilled RN with extensive Utilization Review and Case Management experience who can work efficiently in a fast-paced acute care environment.
 

Responsibilities:

  • Perform 25–30 utilization reviews per day while ensuring timely and accurate documentation.
  • Review medical necessity using InterQual and MCG Criteria.
  • Complete utilization reviews utilizing standardized documentation templates.
  • Collaborate with physicians, case managers, and interdisciplinary teams regarding patient status and level of care.
  • Ensure compliance with payer guidelines, regulatory standards, and hospital policies.
  • Utilize Cerner EMR for documentation and patient review activities.
  • Participate in weekend coverage on a rotating schedule (every 3rd weekend).

Minimum Qualifications:

  • Active Registered Nurse (RN) License.
  • Minimum 5 years of recent RN experience.
  • 2–3 years of recent Utilization Management/Utilization Review or Case Management experience.
  • Case Managers with strong Utilization Management experience will be considered.
  • Previous travel assignment experience is required.
  • Hands-on experience with:
    • Cerner EMR
    • InterQual
    • MCG Criteria
    • Standardized Templates
  • Ability to independently complete 25–30 reviews per day.
  • Must be available to work 100% onsite (Remote work is not available).

Preferred Qualifications:

  • ACM (Accredited Case Manager) or CCM (Certified Case Manager) Certification.

Why Apply?

  • Competitive pay rates.
  • Immediate interview opportunities.
  • Work with a respected healthcare organization.
  • Long-term assignment with a stable schedule.
  • Opportunity to make an impact in patient care and resource management.

📩 We're actively interviewing and submitting qualified candidates. Apply today if you meet the requirements or know someone who would be a great fit!

About Encode INC
At Encode, we empower organizations and individuals through innovative, human-centric workforce and technology solutions. With decades of experience and a proven track record, we deliver more than just healthcare staffing, we provide integrated, strategic support across industries, with particular strength in federal and government contracts.
Benefits
  • 401k retirement plan
  • Vision benefits
  • Dental benefits
  • Referral bonus
  • Life insurance
  • Medical benefits

Apply