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Utilization Review Support Jobs in Ohio (NOW HIRING)

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... screening reviews of the assigned patient population during the episode of care under defined ... Accurate and efficient application of screening criteria will be applied to identify and support ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... screening reviews of the assigned patient population during the episode of care under defined ... Accurate and efficient application of screening criteria will be applied to identify and support ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... screening reviews of the assigned patient population during the episode of care under defined ... Accurate and efficient application of screening criteria will be applied to identify and support ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... screening reviews of the assigned patient population during the episode of care under defined ... Accurate and efficient application of screening criteria will be applied to identify and support ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... screening reviews of the assigned patient population during the episode of care under defined ... Accurate and efficient application of screening criteria will be applied to identify and support ...

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Utilization Review Support information

How to become a utilization review support?

To become a utilization review support, candidates typically need a high school diploma or equivalent, with some roles preferring an associate's or bachelor's degree in healthcare, nursing, or a related field. Relevant skills include knowledge of medical terminology, insurance processes, and familiarity with electronic health records; certifications such as the Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP) can enhance prospects. On-the-job training is common, and strong communication and organizational skills are essential for success in this role.

Is utilization review support work from home?

Utilization review support roles can often be performed remotely, especially with the increased adoption of telecommuting in healthcare administration. Many employers offer work-from-home options, provided the employee has access to necessary tools like secure communication platforms and understands compliance requirements. However, some positions may require on-site presence for certain tasks or meetings.

What does a utilization review support do?

A utilization review support professional assists in evaluating medical services to ensure they are necessary and appropriate, often reviewing patient records and insurance policies. They work closely with healthcare providers and insurance companies, using tools like electronic health records and adhering to industry guidelines to facilitate efficient approval processes.

What cities in Ohio are hiring for Utilization Review Support jobs?

Cities in Ohio with the most Utilization Review Support job openings:

MANAGER OF UTILIZATION REVIEW

North Olmsted, OH

Southwest General
Hospitals • 1 - 5K employees
Learn more about Southwest Generalexternal

Full-time

Posted 11 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

Job description

Summary

  • POSITION INFORMATION
    • Position summary:
      • The Utilization Management (UM) RN Manager is responsible for the day-to-day leadership, operational oversight, and performance management of the Utilization Management nursing team. Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer requirements, approved clinical review criteria, and organizational priorities into consistent daily execution.
      • The role provides direct supervision, coaching, workflow management, clinical-operational support, and performance oversight for assigned UM staff. The Manager collaborates with physician advisors/medical directors, case management, clinical operations, revenue cycle, payer relations, quality, compliance, and other stakeholders to support timely, accurate, evidence-informed utilization management decisions and appropriate stewardship of healthcare resources.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelor of Science in Nursing (BSN) required, or equivalent qualification consistent with organizational policy.
      • Masters degree in Nursing, Healthcare Administration, Business Administration, Public Health, or a related field preferred.

    • Required length and type of experience:
      • Five or more years of progressive clinical nursing and/or utilization management experience preferred, including three or more years of experience in utilization management, utilization review, case management, managed care, or a closely related function.
      • Prior formal leadership experience required; two or more years of supervisory or management experience preferred.

    • Required licensure, certification or registry:
      • Current Ohio State Board of Nursing license required.
      • Certified Case Manager (CCM) certification preferred.
      • Accredited Case Manager (ACM) certification preferred.
    • Core Knowledge, Skills, and Competencies
      • Knowledge of utilization management and utilization review principles, including prospective, concurrent, and retrospective review.
      • Knowledge of medical necessity, patient status, level-of-care review, authorization processes, payer requirements, denial prevention, and escalation pathways.
      • Knowledge of evidence-based clinical review criteria and appropriate use of clinical decision-support tools.
      • Knowledge of regulatory and accreditation requirements affecting utilization management and clinical review.
      • Demonstrated ability in people leadership, coaching, performance management, conflict resolution, and change management.
      • Demonstrated ability to interpret operational analytics and KPIs, conduct root-cause analysis, and drive process improvement.
      • Demonstrated ability to communicate effectively across interdisciplinary teams, including nursing, physicians, physician advisors, payers, revenue cycle, and leadership.
      • Demonstrated application of professional nursing judgment, ethical practice, confidentiality, and appropriate stewardship of healthcare resources.

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