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Utilization Review Support Jobs in Ohio (NOW HIRING)

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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:

UTILIZATION SPECIALIST-E.D.

Hudson, OH • On-site

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

Full-time

Re-posted 26 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

  • POSITION INFORMATION
    • Position summary:
      • The utilization specialist in the Emergency Department (ED) will formulate a patient status recommendation for observation or inpatient status, after thorough review of patient assessments during the workup process and collaborate with the ED physicians. This role will also ensure that the daily surgery schedule is up to date and with correct status and coding. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the utilization specialist facilitates the quality of health care delivery in the most cost-effective manner. The utilization specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The utilization specialist will work collaboratively with management, staff, and departments involved in the patient's plan of care. The utilization specialist's responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization specialists will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding assigned level of care and associated resource utilization.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Graduation from an accredited School of Nursing. BSN graduate preferred.
    • Required length and type of experience:
      • Minimum of five (5) years of recent experience in clinical nursing or related nursing fields. (e.g., Utilization Review or Case Management)
      • Previous Care Management, Case Management or Utilization Management Experience preferred.
      • Previous experience with screening criteria (i.e., Interqual, MCG) preferred.
      • Excellent critical thinking and communication skills
      • Strong computer skills
    • Required licensure, certification or registry:
      • Current licensure by Ohio State Board of Nursing.
      • ACM/CCM Certification helpful

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