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Remote Utilization Review Rn Jobs in Columbus, OH

syfs

UR Manager

Columbus, OH

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

Blacklick, 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

Blacklick, 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 ...

TEEMA Group

Registered Nurse - RN

Columbus, OH · On-site

$85K - $95K/yr

The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...

TEEMA Group

Registered Nurse - RN

Columbus, OH · On-site

$85K - $95K/yr

The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...

TEEMA Group

Registered Nurse - RN

Columbus, OH · On-site

$85K - $95K/yr

The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...

TEEMA Group

RN Home Health

Columbus, OH · On-site

$85K - $95K/yr

Registered Nurse (RN) Care Manager - Home Health Role Summary: The Registered Nurse (RN) Care ... Participate actively in team meetings, quality improvement projects, and utilization review ...

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How much do remote utilization review rn jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote utilization review rn in Columbus, OH is $39.51, according to ZipRecruiter salary data. Most workers in this role earn between $31.20 and $45.38 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

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 are popular job titles related to Remote Utilization Review Rn jobs in Columbus, OH? For Remote Utilization Review Rn jobs in Columbus, OH, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Columbus, OH look for? The top searched job categories for Remote Utilization Review Rn jobs in Columbus, OH are:
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Remote Utilization Review Rn jobs near you

Utilization Review (UR) Specialist

Dove Recovery

Columbus, OH • On-site

Full-time

Posted 10 days ago

Job description

Utilization Review (UR) Specialist
Position Title: Utilization Review Specialist
Department: Clinical / Billing Operations
Reports To: Executive Director & Clinical Director
FLSA Status: Full-Time, Salaried
Location: Dove / Robin Recovery Facilities
Salary Range: 75-85K
Position Summary
The Utilization Review (UR) Specialist is responsible for managing all aspects of authorization, continued stay requests, and utilization review activities for clients receiving treatment services. This position ensures that all clinical documentation submitted to Medicaid and commercial payers meets medical necessity standards, aligns with state and payer requirements, and supports timely approval of authorized days and service units.
The UR Specialist works closely with the Clinical Director, therapists, case management, and billing teams to ensure all documentation is complete, accurate, and submitted within required timelines to maintain uninterrupted client care and maximize revenue reimbursement.
Key Responsibilities
Authorization & Utilization Review
  • Obtain initial authorizations for treatment episodes across all levels of care (PHP, IOP, SUD OP, TBS/PSR, Med Management).
  • Complete continued stay reviews (CSRs) and reauthorization requests by the required deadlines.
  • Submit Medicaid prior authorization (PA) packets including clinical documentation, notes, assessments, and treatment plans.
  • Monitor authorization status in payer portals and maintain communication with Medicaid MCOs (CareSource, Buckeye, Molina, Paramount, UHC, AmeriHealth, etc.).
Documentation & Medical Necessity
  • Review clinical documentation to ensure it meets medical necessity standards required by ODM (Ohio Department of Medicaid) and payer guidelines.
  • Verify that progress notes, assessments, treatment plans, and signatures are complete, accurate, and compliant.
  • Assist clinicians in identifying documentation gaps or areas needing clarification for successful authorization.
  • Ensure timely collection of required documents, including:
    • Comprehensive assessments
    • ASAM Level of Care justifications
    • Treatment plans
    • Progress notes
    • Urine drug screens
    • Psychiatric evaluations
    • Discharge summaries
Coordination & Communication
  • Communicate with Clinical Director and therapists regarding upcoming authorization deadlines, missing documentation, and required updates.
  • Collaborate with billing to ensure authorized units match billed services and resolve discrepancies.
  • Maintain an organized authorization tracker with start dates, end dates, units, and approvals.
  • Respond promptly to payer inquiries and clinical review requests.
Compliance & Quality Assurance
  • Maintain compliance with Medicaid, ODM, CARF/Joint Commission, OhioMHAS, and payer utilization management policies.
  • Ensure documentation standards meet payer audits and state regulatory requirements.
  • Follow up on denials and submit appeals with corrected documentation when appropriate.
Qualifications
Required:
  • Minimum 2 years’ experience in Utilization Review, Medicaid authorization, Behavioral Health Billing, Case Management, or similar role.
  • Strong knowledge of Medicaid MCO authorization portals and processes.
  • Familiarity with medical necessity documentation for behavioral health/SUD.
  • Understanding of ASAM Criteria and justification for levels of care.
  • Ability to read and interpret clinical notes and assessments.
  • Strong communication and coordination skills between clinical and billing departments.
  • High attention to detail and ability to meet strict deadlines.
Preferred:
  • Experience in a Substance Use Disorder or Mental Health treatment center.
  • Knowledge of Alleva EMR or similar EMR platforms.
  • CDCA, QMHS, LSW, or similar credential (not required but beneficial).
Performance Expectations
  • Maintain >95% authorization retention rate for all active clients.
  • Submit all prior authorizations and continued stay reviews before expiration.
  • Zero preventable authorization lapses due to missing documentation.
  • Maintain accurate and up-to-date authorization logs and communication records.
Work Environment
  • Fast-paced behavioral health environment.
  • Remote flexibility depending on needs of department.
  • Requires effective communication with clinical providers and payer representatives.

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