... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
RN Patient Navigator, Utilization Review - Full Time
Riverside, OH · On-site
$53 - $83/hr
Collaborates with staff nurses and physicians to ensure all elements for core measures have been met prior to discharge. * Conducts clinical review process according to Utilization Management Plan.
New
RN Patient Navigator, Utilization Review - Full Time
Riverside, OH · On-site
$53 - $83/hr
Collaborates with staff nurses and physicians to ensure all elements for core measures have been met prior to discharge. * Conducts clinical review process according to Utilization Management Plan.
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
... reviews within the established time frames * Provides clinical and nurse consultations * Identifies ... Performs utilization review and case management support on complex members * Provides support over ...
New
The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office ...
Quick apply
The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office ...
Registered Nurse - Utilization Manager
Wright-patterson Air Force Base, OH · On-site
$44.92/hr
The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office ...
Registered Nurse - Utilization Manager
Wright-patterson Air Force Base, OH · On-site
$44.92/hr
The Registered Nurse - Utilization Manager must have the ability to sit or stand for extended periods while reviewing medical records and working on a computer, with frequent use of standard office ...
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
CSI ANALYST
Dayton, OH · On-site
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
CSI ANALYST
Dayton, OH · On-site
Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements:
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... staff including physicians, nurses, physician assistants, and advanced practice providers ... Utilization Review: Oversee and provide clinical supervision of the hospital's utilization review ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
... utilization patterns of care. The Care Manager is also responsible for developing plans for ... Review of readmission risk assessment tool ,barrier assessment and alleviation * Facilitation of ...
Utilization Review Nurse information
See Springfield, OH salary details
$19.27 - $23.17
2% of jobs
$23.17 - $27.07
9% of jobs
$29.73 is the 25th percentile. Wages below this are outliers.
$27.07 - $30.96
21% of jobs
The median wage is $34.12 / hr.
$30.96 - $34.86
23% of jobs
$34.86 - $38.76
13% of jobs
$41.79 is the 75th percentile. Wages above this are outliers.
$38.76 - $42.66
10% of jobs
$42.66 - $46.55
8% of jobs
$46.55 - $50.45
5% of jobs
$50.45 - $54.35
5% of jobs
$54.35 - $58.25
2% of jobs
$58.25 - $62.14
2% of jobs
$19
$38
$62
How much do utilization review nurse jobs pay per hour?
As of Sep 4, 2026, the average hourly pay for utilization review nurse in Springfield, OH is $38.09, according to ZipRecruiter salary data. Most workers in this role earn between $30.10 and $43.75 per hour, depending on experience, location, and employer.
What does a utilization review nurse do?
A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.
What does a utilization review nurse do?
A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.
What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?
Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.
What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?
To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.
What is the difference between Utilization Review Nurse vs Case Manager?
| Aspect | Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, insurance companies, community health settings |
| Employer & Industry Usage | Primarily in insurance and healthcare organizations for reviewing medical necessity | In healthcare and insurance for coordinating patient care and discharge planning |
Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.
More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Springfield, OH?
The most popular types of Utilization Review Nurse jobs in Springfield, OH are:
What are popular job titles related to Utilization Review Nurse jobs in Springfield, OH?
For Utilization Review Nurse jobs in Springfield, OH, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Springfield, OH look for?
The top searched job categories for Utilization Review Nurse jobs in Springfield, OH are:
What cities near Springfield, OH are hiring for Utilization Review Nurse jobs?
Cities near Springfield, OH with the most Utilization Review Nurse job openings:
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 15 days ago
Job description
About Us
Specialized Care for the Patients Who Need It Most.
NeuroPsychiatric Hospitals (NPH) is dedicated to providing unparalleled service to our patients, team members, physicians, and families. We dare to do things differently, bringing together compassionate care, specialized expertise, and an interdisciplinary approach to meet the unique needs of those we serve. It is this commitment that distinguishes NPH as the healthcare provider of choice.
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute psychiatric and complex medical needs. Our hospitals provide patient-centered care through an interdisciplinary, multi-specialty approach, ensuring our patients receive the specialized support they need when they need it most.
With locations in Indiana, Michigan, Texas, Ohio, and Arizona, we are expanding access to our unique model of care across the United States. Join NPH and become part of a team that is daring to do things differently and making a lasting difference in the lives of our patients, families, and communities every day.
Overview
North Valley Behavioral Hospital, a brand new psychiatric hospital within the NeuroPsychiatric Hospitals network, is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
Responsibilities
Qualifications
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW
Specialized Care for the Patients Who Need It Most.
NeuroPsychiatric Hospitals (NPH) is dedicated to providing unparalleled service to our patients, team members, physicians, and families. We dare to do things differently, bringing together compassionate care, specialized expertise, and an interdisciplinary approach to meet the unique needs of those we serve. It is this commitment that distinguishes NPH as the healthcare provider of choice.
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute psychiatric and complex medical needs. Our hospitals provide patient-centered care through an interdisciplinary, multi-specialty approach, ensuring our patients receive the specialized support they need when they need it most.
With locations in Indiana, Michigan, Texas, Ohio, and Arizona, we are expanding access to our unique model of care across the United States. Join NPH and become part of a team that is daring to do things differently and making a lasting difference in the lives of our patients, families, and communities every day.
Overview
North Valley Behavioral Hospital, a brand new psychiatric hospital within the NeuroPsychiatric Hospitals network, is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
- Competitive pay rates
- Medical, Dental, and Vision Insurance
- NPH 401(k) plan with up to 4% Company match
- Employee Assistance Program (EAP) Programs
- Generous PTO and Time Off Policy
- Special tuition offers through Capella University
- Work/life balance with great professional growth opportunities
- Employee Discounts through LifeMart
Responsibilities
- Filing documents as needed.
- Initial Precertification with payors.
- Concurrent Clinical review with payors.
- Document in the electronic system daily in real time.
- Admission audit.
- Ensures that CON's/RON's and CMS certifications are completed by provider.
- Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
- Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
- Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
- Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
- Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
- Complies with hospital expectations regarding ethical behavior and standards of conduct.
- Complies with federal and hospital requirements in the areas of protected health information and patient information.
- Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
- Provides education to nursing staff. leadership team, and providers regarding documentation.
- Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.
Qualifications
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW