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Rn Utilization Management Jobs Near Me

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UR Manager

Columbus, OH · On-site

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

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · On-site

$29.05 - $56.64/hr

... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ...

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 ...

Molina Healthcare

Medical Review Nurse (RN)

Columbus, OH · Remote

$29.05 - $56.64/hr

... utilization management and long-term services and supports (LTSS) issues. • Identifies and ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Compact ...

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How much do rn utilization management jobs pay per year?

As of Aug 12, 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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Rn Utilization Management jobs near you
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.

Utilization Review Clinician (RN) - Behavioral Health

Molina Healthcare

Columbus, OH • On-site

$23.76 - $51.49/hr

Other

Posted 5 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

163rd of 304 rated insurance

Job description

Behavioral Health Experience Required.

Seeking a Registered Nurse with a OH or compact license.

The Care Review Clinician will provide prior authorization for behavioral health services for the OH Medicaid population. Strong behavioral health care experience (Inpatient Mental Health/Psych, Substance Use Disorder, Rehabilitation/withdrawal management, outpatient BH related services etc). Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good analytical thought process is important to be successful in this role. Prefer candidates that have experience with ASAM, MCG or previous experience with Utilization Reviews.

SCHEDULE: Monday thru Friday 8:00AM to 5:00PM EST (Rotating weekends and Holiday schedules are required for this position.) Once orientation period has finished, employee may be eligible for an alternative work schedule.

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

  • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.

  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.

  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.

  • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.

  • Processes requests within required timelines.

  • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.

  • Requests additional information from members or providers as needed.

  • Makes appropriate referrals to other clinical programs.

  • Collaborates with multidisciplinary teams to promote the Molina care model.

  • Adheres to utilization management (UM) policies and procedures.

Required Qualifications

  • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.

  • Registered Nurse (RN). License must be active and unrestricted in state of practice.

  • Ability to prioritize and manage multiple deadlines.

  • Excellent organizational, problem-solving and critical-thinking skills.

  • Strong written and verbal communication skills.

  • Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

  • Certified Professional in Healthcare Management (CPHM).

  • Behavioral health experience preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $23.76 - $51.49 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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