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

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

Acadia Healthcare

Registered Nurse

Columbus, OH

$36 - $44.75/hr

Demonstrate knowledge and utilization of universal precautions in providing direct patient care ... Must possess a current Registered Nurse (RN) license as required by the state of employment or be ...

Acadia Healthcare

Registered Nurse

Columbus, OH · On-site

$36 - $44.75/hr

Responsibilities REGISTERED NURSE (RN) ESSENTIAL FUNCTIONS * Provide and coordinate care by ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.

Acadia Healthcare

Registered Nurse

Columbus, OH · On-site

$36 - $44.75/hr

Responsibilities REGISTERED NURSE (RN) ESSENTIAL FUNCTIONS * Provide and coordinate care by ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.

Trinity Health

RN Case Manager

Westerville, OH · On-site

Our RN Case Manager in collaboration with other internal and external disciplines directs and ... This is done with the intentions of cost effective utilization of hospital resources, minimizing ...

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Utilization Review Rn information

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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:
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What job categories do people searching Utilization Review Rn jobs in Columbus, OH look for? The top searched job categories for Utilization Review Rn jobs in Columbus, OH are:
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
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 Case Manager

Sheakley

Columbus, OH • On-site

Full-time

Posted 18 days ago

Job description

Job Summary: The Case Manager serves as the primary clinical contact for injured workers, coordinating care and facilitating safe, timely return-to-work outcomes. This role involves assessing treatment plans, collaborating with medical providers, employers, and insurers, and ensuring quality, compliance, and effective communication across all parties. The Case Manager must exercise strong clinical judgment, organizational skills, and maintain confidentiality.

QUALIFICATIONS:

  • A current, unrestricted Ohio state licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline
  • Eligibility to hold a multi-state licenses as needed to meet the needs of the company
  • Two years full-time equivalent of direct clinical care to the consumer and
  • Prefer a minimum of one (1) year of active case management experience in worker's compensation
  • Maintains continuing education as required to maintain licensure and certification
  • Excellent leadership, verbal/written communication skills, strong organizational skills, and excellent decision making and judgment

ROLE AND RESPONSIBILITIES FOR THE CASE MANAGER:

  • Reports directly to The Case Management Team Lead
  • Serve as the first point of post-injury contact after triage, developing and managing return to work opportunities with injured workers, designated network providers, and employer contacts
  • Assess the appropriateness of the level of care, diagnostic tests and clinical procedures for utilization review on a concurrent basis
  • Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion
  • Assess quality and clinical risk issues on a concurrent basis; report any recognized issue to the Case Management Team Lead
  • Assess documentation of medical records for completeness on a concurrent basis
  • Ability to obtain and interpret information appropriate to injured workers' needs as required for assessment, treatment, and patient care services
  • Assess, develop, implement and monitor plan of care;
  • Initiate communication and consistently communicate with the injured worker, employer, provider, BWC, and TPA (five-point contact, which could include attorney for IW/employer)
  • Provide education and guidance to all parties to the claim; this includes: claim review at staffings, and/or providing direction to any member of the five-point contact
  • Develop and maintain a positive work atmosphere and support overall team; demonstrate ability to work within a team structure
  • Practice capable and effective problem identification and resolution skills as a method of sound decision making
  • Maintain confidentiality
  • Work independently, efficiently, and deal with priorities
  • Understand and uphold UniComp philosophy and demonstrate commitment to UniComp's core values: have a sense of urgency, be optimistic, promote independence, and respect human dignity
  • Perform other duties as assigned
  • Practice nursing within the Scope of Practice as designated by the State of Ohio Board of Nursing
  • Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.