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

TEEMA Group

RN Home Health

Columbus, OH · On-site

$85K - $95K/yr

Registered Nurse (RN) Care Manager - Home Health Role Summary: The Registered Nurse (RN) Care ... Participate actively in team meetings, quality improvement projects, and utilization review ...

TEEMA Group

RN Home Health

Columbus, OH · On-site

$85K - $95K/yr

Registered Nurse (RN) Care Manager - Home Health Role Summary: The Registered Nurse (RN) Care ... Participate actively in team meetings, quality improvement projects, and utilization review ...

LMHS

RN Case Manager - Case Management

Newark, OH · On-site

RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...

LMHS

RN Case Manager - Case Management

Newark, OH · On-site

RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...

TEEMA Group

RN Care Manager

Columbus, OH · On-site

$85K - $95K/yr

The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...

TEEMA Group

RN Care Manager

Columbus, OH · On-site

$85K - $95K/yr

The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...

Sheakley

RN Case Manager

Columbus, OH · On-site

Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab ... Practice nursing within the Scope of Practice as designated by the State of Ohio Board of Nursing

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How much do utilization review rn jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review rn in Columbus, OH is $40.84, according to ZipRecruiter salary data. Most workers in this role earn between $32.26 and $46.92 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.

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.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.

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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The top searched job categories for Utilization Review Rn jobs in Columbus, OH are:

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Cities near Columbus, OH with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Columbus, OH as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution, with an average salary of $84,947 per year, or $40.8 per hour.

RN Clinical Coordinator/Case Manager (50/50 Role)

Licking Memorial Hospital

Newark, OH • On-site

Full-time

Posted 12 days ago

Licking Memorial Hospital rating

7.2

Company rating: 7.2 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

428th of 1,059 rated hospitals

Job description

RN Case Manager

Position Summary

The Clinical Coordinator/Case Manager serves in a dual-capacity role, dedicating approximately 50% of time to clinical coordination and department operations and 50% of time to direct patient case management activities. This position supports the coordination and oversight of care management processes while maintaining an active caseload to ensure high-quality, patient-centered care across the continuum.

As a Clinical Coordinator, the incumbent provides day-to-day operational support, assists with workflow management, staff onboarding and education, quality initiatives, compliance monitoring, and serves as a resource to the interdisciplinary team. The role promotes adherence to regulatory requirements, organizational policies, and best practices in care coordination and utilization management.

As a Case Manager, the incumbent conducts patient assessments, develops and implements individualized discharge plans, coordinates transitions of care, collaborates with physicians and interdisciplinary team members, and advocates for patients to ensure appropriate utilization of resources and timely progression of care. The role focuses on achieving optimal clinical, financial, and patient satisfaction outcomes while supporting safe and effective care transitions.

This position requires strong clinical judgment, leadership skills, effective communication, and the ability to balance operational responsibilities with direct patient care coordination in a fast-paced healthcare environment.

Responsibilities

  • Serve as the primary clinical administrator for Case Management/ Utilization Review applications such as:
    • MCG- Milliman Care Guidelines
    • R1- Physician Advisor
    • Payer Portal Administrator
  • Coordinate all aspects of new hire orientation including (not all inclusive):
    • Development of Orientation Calendar
    • Assignment of Preceptors
    • Hardware/ Software Needs and Accesses
    • Preceptor/ Preceptee Documentation-Support
    • Develop/ Maintain New Hire Orientation Manuals
  • Develop/ Ensure Annual Case Management Competencies
    • MCG: Interrater Reliability
    • MCG LMS Coursework
    • DNV/JC Case Management Competencies
  • Collaborate with Health System Clinical Coordinators
    • Preceptor Training
  • Develop and Maintain Case Management Education Calendar
    • Design and Facilitate Education surrounding EPIC upgrades/ changes.
    • Facilitate clinical education on current best practices
  • Develop/ Maintain CM Database with all CM related education/ resources
  • Serve as Expert/ Maintain knowledge of all CM related functions and workflows including:
    • Utilization Review
    • Denials/ Appeals Management
    • Discharge Planning
    • Medicare Compliance
    • Mental Health/ Substance Use
    • Readmission Reduction
  • Perform all duties as assigned in Case Management Role

Requirements

  • Current R.N. licensure in Ohio (must be maintained)
  • 2 years active Acute Case Management Experience
  • Obtain Case Management Certification within one year of employment in role
  • Current CPR card and maintain.
  • Maintain knowledge of new technology and equipment
  • Ability to work independently.
  • Successful candidate must have excellent critical thinking skills.
  • LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, color, religion, sex, sexual orientation, age, ancestry, national origin, veteran status, pregnancy, disability, marital status, or other characteristics protected by law.

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