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Utilization Review Rn Jobs in Columbus, OH (NOW HIRING)

syfs

UR Manager

Columbus, OH

Job Duties Review medical records to determine appropriateness of admissions, procedures and ... affecting utilization management. PositionRequirements Bachelor's degree required. Active RN ...

Interim HealthCare

RN Case Manager

Columbus, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH · On-site

$80K - $85K/yr

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

PRN RN Case Manager

Blacklick, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Salo, Inc Career Site

PRN RN Case Manager

Blacklick, OH · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Salo, Inc Career Site

PRN RN Case Manager

Blacklick, OH · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

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Utilization Review Rn information

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$62

How much do utilization review rn jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for utilization review rn in Columbus, OH is $38.50, according to ZipRecruiter salary data. Most workers in this role earn between $30.43 and $44.23 per hour, depending on experience, location, and employer.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Columbus, OH? The most popular types of Utilization Review Rn jobs in Columbus, OH are:
What are popular job titles related to Utilization Review Rn jobs in Columbus, OH? For Utilization Review Rn jobs in Columbus, OH, the most frequently searched job titles are:
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What cities near Columbus, OH are hiring for Utilization Review Rn jobs? Cities near Columbus, OH with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Utilization Review Specialist

Utilization Review Specialist

Lighthouse Behavioral Health Solutions

Columbus, OH

Other

Posted 6 days ago

Job description

Position: Utilization Review Specialist

Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care.

Reports to: VP of Revenue Cycle Management

Duties and Responsibilities:

Duties include, but are not limited to:

  • Conduct initial and concurrent reviews to determine medical necessity using established criteria
  • Submit authorization requests and clinical documentation to insurance providers in a timely manner
  • Monitor authorizations and ensure services rendered align with approved levels of care
  • Track and manage authorization expirations and initiate reauthorization requests as needed
  • Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards
  • Ensure treatment plans, progress notes, and discharge summaries support medical necessity
  • Provide feedback to clinical staff to improve documentation quality
  • Maintain adherence to HIPAA and confidentiality regulations
  • Serve as the primary liaison between the organization and insurance companies for utilization review matters
  • Participate in peer-to-peer reviews when required
  • Address denials by gathering supporting documentation and submitting appeals
  • Stay current with payer guidelines and regulatory changes affecting SUD services
  • Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of care and proper utilization of services
  • Participate in multidisciplinary team meetings to discuss patient progress and level-of-care needs
  • Communicate authorization status and payer requirements to relevant staff
  • Maintain accurate records of authorizations, denials, and appeals
  • Track utilization metrics and identify trends to improve efficiency and reimbursement
  • Participate in audits and quality assurance initiatives
  • Perform other duties as assigned

Required Experience/Abilities:

  • Bachelor's degree in behavioral health, nursing, social work, or a related field required.
  • Knowledge of ASAM Criteria required
  • Minimum of 1 year of experience in utilization review, case management, or clinical services within behavioral health or SUD treatment
  • Experience working with commercial insurance, Medicaid, and/or Medicare preferred
  • Familiarity with electronic health record (EHR) systems
  • Must pass BCI check, all Corporate Compliance checks, and employment drug screen

Desired Experience/Abilities:

  • Master's degree or clinical licensure (e.g., LSW, LPC, LCSW, RN) preferred.3 years in a supervisory or management role within a behavioral health setting
  • Working knowledge of CPT and ICD-10 coding systems, with relevant certification (e.g., CPC, CCS-P) or equivalent experience
  • Understanding of medical necessity criteria, including experience with InterQual and/or Milliman (MCG) guidelines

Location: Columbus, OH

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