Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...
Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...
Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...
Helping to manage an over $ 7million/ year hospital utilization contract * Reviewing necessary medical record reviews and making a determination on hospital appeals. * Supervising and training RNs, ...
Review requests for contract specific prior authorization of services within a centralized unit ... Utilization review, prior authorization, or managed care experience preferred. * Active OH RN ...
Review requests for contract specific prior authorization of services within a centralized unit ... Utilization review, prior authorization, or managed care experience preferred. * Active OH RN ...
Utilization Management Representative II
Columbus, OH · On-site
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
Utilization Management Representative II
Columbus, OH · On-site
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
Utilization Management Representative II
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
Utilization Management Representative II
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
Utilization Management Representative II
Columbus, OH · On-site
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
Utilization Management Representative II
Columbus, OH · On-site
$17.33 - $26.59/hr
Determines contract and benefit eligibility; provides authorization for inpatient admission ... Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty ...
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
We are one of the nation's leading administrators of government contracts. We operate one of the ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:
Appeals Medical Director- Cardiology
$247K - $446K/yr
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
Appeals Medical Director- Cardiology
$247K - $446K/yr
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
... when conducting utilization review or an appeals consideration and cannot be located on a US ... Additional experience may be required by State contracts or regulations if the Medical Director is ...
Director of Rehabilitation
Westerville, OH · On-site
$90 - $130/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... Participate in interdisciplinary meetings including utilization review, quality assurance, resident ...
Director of Rehabilitation
Westerville, OH · On-site
$90 - $130/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... Participate in interdisciplinary meetings including utilization review, quality assurance, resident ...
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... utilization review, quality assurance, resident care conferences, admissions, department head ...
Director of Rehabilitation
Westerville, OH · On-site
$90 - $130/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... Participate in interdisciplinary meetings including utilization review, quality assurance, resident ...
Director of Rehabilitation
Westerville, OH · On-site
$90 - $130/hr
As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical ... Participate in interdisciplinary meetings including utilization review, quality assurance, resident ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
... utilization review, compliance notifications, wellness information, and any other items deemed ... of contracts. * Captures all meeting notes and activities during client-facing sessions and ...
Case Manager
Westerville, OH · On-site
$19.50 - $25/hr
Understand commercial contract levels, exclusions, payor requirements, and recertification needs ... Participate in utilization review process: data collection, trend review, and resolution actions.
Case Manager
Westerville, OH · On-site
$19.50 - $25/hr
Understand commercial contract levels, exclusions, payor requirements, and recertification needs ... Participate in utilization review process: data collection, trend review, and resolution actions.
Contract Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do contract utilization review jobs pay per hour?
As of Aug 9, 2026, the average hourly pay for contract utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.
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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
Columbus, OH • On-site
Full-time
This job post has expired 1 day ago. Applications are no longer accepted.
Job description
What You Will Do At ODM:
Office: Legal Counsel
Bureau: Program Integrity
Classification: Medicaid Health Systems Administrator 1 RN (PN: 20092018)
Job Overview:
The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS). SURS is charged with helping the agency review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate payments to providers. As a Clinical Review Nurse Supervisor your responsibilities will include:
- Helping to manage an over $ 7million/ year hospital utilization contract
- Reviewing necessary medical record reviews and making a determination on hospital appeals.
- Supervising and training RNs, Auditors, and Analysts in identifying fraud, waste, and abuse in the Medicaid program.
- Participating/leading meetings with external stakeholders including law enforcement
- Developing and implementing changes to processes and procedures as needed in a team environment
- Evaluating provider clinical compliance with state and federal Program Integrity rules
- Evaluating provider medical documentation and billing practices for fraud, waste and abuse
- Recovering overpayments for medically unnecessary services via administrative procedures and/or referrals to health oversight agencies
- Responding to provider clinical reconsideration (appeal) requests
- Consulting on clinical matters with ODM policy units and other state agencies
- Coordinating clinical Program Integrity efforts with ODM contractors and managed care plans
- Presenting findings from clinical reviews of provider non-compliance
- Responding to inquiries from the public, consumers, providers, and other agencies
Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis); Current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03-4723.09 of Ohio Revised Code;
Or 12 months experience as Medicaid Health Systems Specialist, 65293, may be substituted for the experience required, but not for the mandated licensure.
Note: education & experience is to be commensurate with approved position description on file.
-Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Technical Skills: Nursing
Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication