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Rn Utilization Management Jobs Near Me

syfs

UR Manager

Columbus, OH

Maintain compliancy with regulation changes affecting utilization management. PositionRequirements Bachelor's degree required. Active RN License from an accredited nursing school Minimum three to ...

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 ...

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As of Aug 14, 2026, the average yearly pay for rn utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

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A map of the United States highlighting the number of Rn Utilization Management job openings by state according to ZipRecruiter. The image is accompanied by a detailed chart listing the number of Rn Utilization Management job openings in each state, with California having the most at 2 and Alaska the least at 0.

RN Clinical Appeals & Utilization Review - Remote

BCForward

Columbus, OH • On-site

$50 - $55/hr

Contractor

Medical, Dental, Vision

Posted 2 days ago

New

Job description

BCforward is currently seeking a highly motivated RN Clinical Appeals & Utilization Review for an opportunity in Columbus , OH

Position: RN Clinical Appeals & Utilization Review

Location: Remote – Ohio; Columbus area preferred

Duration: 6 months, with possibility of extension or conversion

Work Type: Remote

Shift: Monday–Friday, 8:00 AM–5:00 PM

Job Information:

The ideal candidate will have experience in Utilization Review/Utilization Management, appeals or authorization review, strong clinical documentation skills, and the ability to independently manage a high volume of appeal cases while meeting compliance and turnaround-time requirements.

Key Responsibilities

  • Perform clinical reviews of medical necessity appeals involving denied authorizations and prior authorization decisions.
  • Review medical records, clinical information, medical codes, authorization documentation, and applicable criteria to determine appropriate appeal outcomes.
  • Analyze denied authorization/prior authorization cases and prepare complete case summaries for Medical Director review.
  • Review medical code data and clinical records to determine whether a denial is supported by applicable criteria and guidelines.
  • Make appeal determinations, document outcomes, send appropriate determination letters, and close cases in the applicable system.
  • Prepare clear and accurate written appeal and authorization outcome letters for members and providers.
  • Maintain complete and accurate appeal files and documentation.
  • Utilize multiple claims and appeals systems to research information and complete clinical reviews.
  • Apply medical necessity criteria, health plan policies, and applicable regulatory and quality standards, including NCQA requirements.
  • Manage approximately 10–15 appeals per day after training while ensuring work queues remain within required compliance turnaround times.
  • Communicate effectively with team members and leadership through email and Microsoft Teams.
  • Adapt to changing priorities and assist with additional team needs as required.
  • Support related health plan activities, including claims research, data entry, tracking, and documentation when needed.
  • Handle large volumes of documents and clinical information while maintaining accuracy and confidentiality.

Required Qualifications

  • Active LPN license required.
  • RN license preferred but not required.
  • Minimum 2 years of Utilization Review/Utilization Management experience.
  • Experience reviewing medical necessity appeals, denied authorizations, or prior authorization cases.
  • Experience reviewing medical records and clinical data to support appeal determinations.
  • Knowledge of medical coding and ability to interpret medical code information.
  • Strong written, verbal, analytical, and problem-solving skills.
  • Comfortable working with multiple clinical, claims, and appeals systems.
  • Proficiency with Microsoft Office programs.
  • Ability to manage a high-volume workload while meeting turnaround-time requirements.

Preferred Qualifications

  • RN license.
  • Direct patient care experience.
  • Experience writing appeal or authorization outcome letters.
  • Experience with TruCare and/or Amisys.
  • Experience with grievance and appeals processes.
  • Experience working in a health plan or managed care environment.
  • Stable work history and demonstrated ability to work independently.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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About BCforward

Sourced by ZipRecruiter

BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. Headquartered in Indianapolis, Indiana, BCforward also operates numerous delivery centers across North America and India. We are currently the largest consulting firm and largest MBE certified firm in Indiana. Our uninterrupted growth has allowed BCforward to deliver uniquely configured IT staffing and project solutions for over years of catering to our customers' specific needs. BCforward currently maintains a team of over 5000 global resources. With our additional brand, Stafforward, together we have the capabilities to deliver services for a variety of industries in both public and private sectors which allows us to address your most challenging needs.

Industry

It services

Company size

5,001 - 10,000 Employees

Headquarters location

Indianapolis, IN, US

Year founded

1998

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