Utilization Management (UM) RN / Utilization Specialist Schedule: Full-Time | 40 Hours/Week ... Review medical necessity using InterQual and MCG Criteria . * Complete utilization reviews ...
Utilization Management (UM) RN / Utilization Specialist Schedule: Full-Time | 40 Hours/Week ... Review medical necessity using InterQual and MCG Criteria . * Complete utilization reviews ...
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application ...
Organizes and manages the activties of the Utilization Review department specifically focusing on clinical utilization reviews, timeliness, accuracy, and denial prevention. Oversees the application ...
Care Review Nurse
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing healthcare members ...
New
Care Review Nurse
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing healthcare members ...
New
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
... reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital ...
Travel o Minimum of five (5) years recent RN experience o Previous Case Management or Utilization ... Utilization Review or Case Management) - Previous Care Management, Case Management or Utilization ...
Travel o Minimum of five (5) years recent RN experience o Previous Case Management or Utilization ... Utilization Review or Case Management) - Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...
Utilization Review Clinician (RN) - Behavioral Health
Columbus, OH · On-site
$23.76 - $51.49/hr
The Care Review Clinician will provide prior authorization for behavioral health services for the ... Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least ...
Utilization Review Clinician (RN) - Behavioral Health
Columbus, OH · On-site
$23.76 - $51.49/hr
The Care Review Clinician will provide prior authorization for behavioral health services for the ... Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least ...
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
Quick apply
SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all ... Monitors and reviews MCO portals to track authorization status, pending requests, approvals ...
Utilization Review Director Shift: M-F Hours: 8-4:30 9-5 The Role Itself * Oversees service ... Manages patient transitions between LOC and updates denial log. * Develops processes to minimize ...
Utilization Review Director Shift: M-F Hours: 8-4:30 9-5 The Role Itself * Oversees service ... Manages patient transitions between LOC and updates denial log. * Develops processes to minimize ...
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong ... Utilization Review Pharmacist opening.
New
Utilization Review Management information
See Ohio salary details
$14.85 - $18.14
14% of jobs
$20.85 is the 25th percentile. Wages below this are outliers.
$18.14 - $21.42
14% of jobs
$21.42 - $24.70
17% of jobs
The median wage is $26.51 / hr.
$24.70 - $27.98
11% of jobs
$27.98 - $31.27
8% of jobs
$31.27 - $34.55
6% of jobs
$37.01 is the 75th percentile. Wages above this are outliers.
$34.55 - $37.83
7% of jobs
$37.83 - $41.11
7% of jobs
$41.11 - $44.40
5% of jobs
$44.40 - $47.68
5% of jobs
$47.68 - $50.96
5% of jobs
$14
$30
$50
How much do utilization review management jobs pay per hour?
As of Aug 12, 2026, the average hourly pay for utilization review management in Ohio is $30.37, according to ZipRecruiter salary data. Most workers in this role earn between $21.25 and $38.61 per hour, depending on experience, location, and employer.
What are the job titles for utilization review management?
Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).
What is the difference between Utilization Review Management vs Utilization Review Nurse?
| Aspect | Utilization Review Management | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a healthcare management or related certification, sometimes a nursing background | Registered Nurse (RN) license, often with additional utilization review certification |
| Work Environment | Office-based, administrative setting, collaborating with healthcare providers and insurance companies | Clinical setting, reviewing patient charts, and making utilization decisions |
| Employer & Industry | Health insurance companies, managed care organizations, healthcare administrators | Hospitals, insurance companies, healthcare facilities |
Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.
What are some common challenges faced by professionals in utilization review management, and how can they be addressed?
Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.
What is utilization review management?
Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.
What are the key skills and qualifications needed to thrive in utilization review management?
To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
$2.6K/wk
Other
Medical, Dental, Vision, Life, Retirement
Posted 9 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. Why Vivian Health?Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app.
Benefits- 401k retirement plan
- Vision benefits
- Dental benefits
- Referral bonus
- Life insurance
- Medical benefits