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Part Time Utilization Review Jobs Near Me

Gifthealth

Onsite Pharmacist - Part-Time

Columbus, OH · On-site

$51.12 - $63.91/hr

Shift: Part-time, as needed weekend hours Location: Columbus, Ohio About Gifthealth Gifthealth is ... Perform Drug Utilization Reviews: Review prescribed medications for safety, efficacy, and ...

giftHEALTH Inc

Onsite Pharmacist - Part-Time

Columbus, OH · On-site

$51.12 - $63.91/hr

Shift: Part-time, as needed weekend hours Location: Columbus, Ohio About Gifthealth Gifthealth is ... Perform Drug Utilization Reviews: Review prescribed medications for safety, efficacy, and ...

Gifthealth

Onsite Pharmacist - Part-Time

Columbus, OH · On-site

$51.12 - $63.91/hr

Shift: Part-time, as needed weekend hours Location: Columbus, Ohio About Gifthealth Gifthealth is ... Perform Drug Utilization Reviews: Review prescribed medications for safety, efficacy, and ...

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How much do part time utilization review jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for part time 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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Part Time Utilization Review jobs near you
A map of the United States highlighting the number of Part Time Utilization Review job openings by state according to ZipRecruiter. The image is accompanied by a detailed chart listing the number of Part Time Utilization Review job openings in each state, with California having the most at 2 and Hawaii the least at 0.
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

Ohio Department of Aging

Columbus, OH • On-site

Full-time

Medical, Dental, Vision, Life, PTO

Posted 10 days ago

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

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:
  • Medical Coverage
  • Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
  • Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
  • Childbirth, Adoption, and Foster Care leave
  • Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
  • Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
Qualifications
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
Ohio Department of Aging logo

About Ohio Department of Aging

Sourced by ZipRecruiter

The Ohio Department of Aging, based in Columbus, OH, US, is within the healthcare and service industry, primarily serving older individuals and their care providers throughout the state. As a state government agency, its key role is to ensure the provision of quality services and supports that assist older Ohioans to live healthier, safer and more productive lives. The department functions through the official website, ohio.gov. It was established with a mission to position the State of Ohio on the leading edge of solution-driven innovation for the challenges and opportunities presented by Ohio's rapidly aging population.

Industry

Public administration

Company size

51 - 200 Employees

Headquarters location

Columbus, OH, US

View All Ohio Department of Aging Jobs

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