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Part Time Utilization Review Rn Jobs in Columbus, OH

Integrated Resources INC

Care Review Nurse

Columbus, OH · On-site

Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses ...

syfs

UR Manager

Columbus, OH · On-site

Job Duties Review medical records to determine appropriateness of admissions, procedures and ... affecting utilization management. PositionRequirements Bachelor's degree required. Active RN ...

Salo, Inc Career Site

RN Case Manager

Columbus, OH · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

RN Case Manager

Columbus, OH · On-site

$80K - $85K/yr

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

Interim HealthCare

PRN RN Case Manager

Blacklick, OH

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. * OASIS experience ...

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All JobsUtilization Review Rn JobsPart Time Utilization Review Rn JobsPart Time Utilization Review Rn Jobs in Columbus, OH

Part Time Utilization Review Rn information

See Columbus, OH salary details

$19

$38

$62

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

As of Jun 17, 2026, the average hourly pay for part time utilization review rn in Columbus, OH is $38.50, according to ZipRecruiter salary data. Most workers in this role earn between $30.43 and $44.23 per hour, depending on experience, location, and employer.

What is the difference between Part Time Utilization Review Rn vs Part Time Case Manager Rn?

AspectPart Time Utilization Review RnPart Time Case Manager Rn
CertificationsRN license, Utilization Review certification (if required)RN license, Case Management certification (e.g., CCM)
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, insurance companies, community health agencies
Primary ResponsibilitiesReview medical necessity, approve or deny services based on criteriaCoordinate patient care, discharge planning, and resource management
Industry UsageCommonly used in insurance and healthcare utilization departmentsUsed in patient care coordination and discharge planning

While both roles require RN licensure, the Part Time Utilization Review Rn focuses on evaluating medical necessity and approving services, whereas the Part Time Case Manager Rn emphasizes coordinating patient care and discharge planning. Understanding these differences helps professionals choose the role that best fits their skills and career goals.

What are some typical challenges faced by Part Time Utilization Review RNs, and how can they be managed?

Part Time Utilization Review RNs often face challenges such as balancing productivity expectations with the complexity of reviewing medical records and ensuring compliance with ever-changing regulations. Working part time can also mean adapting quickly to updates in protocols or software with less training time. Staying organized, maintaining strong communication with the care team, and proactively seeking clarification about criteria changes can help manage these challenges. Additionally, leveraging ongoing education and collaborating with full-time colleagues can ease transitions and support effective performance.

What does a Part Time Utilization Review RN do?

A Part Time Utilization Review RN is a registered nurse who works part-time to assess the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, collaborate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their goal is to promote quality care while managing healthcare costs and ensuring compliance with regulations.

What are the key skills and qualifications needed to thrive as a Part Time Utilization Review RN, and why are they important?

To thrive as a Part Time Utilization Review RN, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and coding systems like ICD-10 is essential. Attention to detail, critical thinking, and effective communication are vital soft skills for collaborating with healthcare providers and payers. These skills ensure accurate assessments, compliance, and efficient resource use, directly impacting patient outcomes and cost management.
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:
What cities near Columbus, OH are hiring for Part Time Utilization Review Rn jobs? Cities near Columbus, OH with the most Part Time Utilization Review Rn job openings:
Part Time Utilization Review Rn jobs near you
Utilization Review Specialist

Utilization Review Specialist

Lighthouse Behavioral Health Solutions

Columbus, OH

Other

Posted 7 days ago

Job description

Position: Utilization Review Specialist

Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care.

Reports to: VP of Revenue Cycle Management

Duties and Responsibilities:

Duties include, but are not limited to:

  • Conduct initial and concurrent reviews to determine medical necessity using established criteria
  • Submit authorization requests and clinical documentation to insurance providers in a timely manner
  • Monitor authorizations and ensure services rendered align with approved levels of care
  • Track and manage authorization expirations and initiate reauthorization requests as needed
  • Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards
  • Ensure treatment plans, progress notes, and discharge summaries support medical necessity
  • Provide feedback to clinical staff to improve documentation quality
  • Maintain adherence to HIPAA and confidentiality regulations
  • Serve as the primary liaison between the organization and insurance companies for utilization review matters
  • Participate in peer-to-peer reviews when required
  • Address denials by gathering supporting documentation and submitting appeals
  • Stay current with payer guidelines and regulatory changes affecting SUD services
  • Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of care and proper utilization of services
  • Participate in multidisciplinary team meetings to discuss patient progress and level-of-care needs
  • Communicate authorization status and payer requirements to relevant staff
  • Maintain accurate records of authorizations, denials, and appeals
  • Track utilization metrics and identify trends to improve efficiency and reimbursement
  • Participate in audits and quality assurance initiatives
  • Perform other duties as assigned

Required Experience/Abilities:

  • Bachelor's degree in behavioral health, nursing, social work, or a related field required.
  • Knowledge of ASAM Criteria required
  • Minimum of 1 year of experience in utilization review, case management, or clinical services within behavioral health or SUD treatment
  • Experience working with commercial insurance, Medicaid, and/or Medicare preferred
  • Familiarity with electronic health record (EHR) systems
  • Must pass BCI check, all Corporate Compliance checks, and employment drug screen

Desired Experience/Abilities:

  • Master's degree or clinical licensure (e.g., LSW, LPC, LCSW, RN) preferred.3 years in a supervisory or management role within a behavioral health setting
  • Working knowledge of CPT and ICD-10 coding systems, with relevant certification (e.g., CPC, CCS-P) or equivalent experience
  • Understanding of medical necessity criteria, including experience with InterQual and/or Milliman (MCG) guidelines

Location: Columbus, OH

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