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Utilization Review Rn Jobs in Columbus, OH (NOW HIRING)

LMHS

RN Case Manager - Case Management

Newark, OH · On-site

RN Case Manager Position Summary The case manager is responsible for individualized management of ... Utilization review and or discharge planning experience preferred * Excellent verbal and written ...

TEEMA Group

RN Care Manager

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 Care Manager

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 ...

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Utilization Review Rn information

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$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of May 30, 2026, the average hourly pay for 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 Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

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 Utilization Review Rn jobs in Columbus, OH? For Utilization Review Rn jobs in Columbus, OH, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Columbus, OH look for? The top searched job categories for Utilization Review Rn jobs in Columbus, OH are:
What cities near Columbus, OH are hiring for Utilization Review Rn jobs? Cities near Columbus, OH with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Columbus, OH as of May 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $82,172 per year, or $39.5 per hour.
RN Case Manager - Case Management

RN Case Manager - Case Management

IntelyCare

Newark, OH

Other

Posted 18 days ago

Job description

RN Case Manager

The case manager is responsible for individualized management of hospital and healthcare services necessary and appropriate to the provision of high quality, cost effective patient care. He or she works with acutely ill and/or high risk clients ranging in age from newborn to the geriatric population. The Case Manager develops collaborative, outcome-oriented plans of care for each patient, acts as a patient advocate and provides mechanisms and support to empower patients to make responsible healthcare decisions while guiding appropriate utilization of resources and services to achieve expected outcomes.

Responsibilities

  • Determines appropriate level of care on admission using hospital approved medical necessity criteria
  • Performs patient and care giver assessments to identify pertinent problems/needs
  • Organizes assessment data into an individual plan of care, with anticipated outcomes
  • Determines continued stay status
  • Participates in multidisciplinary rounds
  • Participates in patient education
  • Tracks and manages potential avoidable hospital days
  • Provides clinical information to external providers and managed care organizations
  • Assists in discharge planning
  • Assists in appeals and denials management

Requirements

  • Graduate of an accredited school of nursing and licensed in the state of Ohio
  • 2 years of clinical experience in an acute care setting
  • Critical care/emergency department experience highly desired
  • Knowledge of evidenced-based practice and disease management protocols
  • Utilization review and or discharge planning experience preferred
  • Excellent verbal and written communication skills
  • Excellent computer skills.
  • LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, color, religion, sex, sexual orientation, age, ancestry, national origin, veteran status, pregnancy, disability, marital status, or other characteristics protected by law.

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About IntelyCare

Sourced by ZipRecruiter

At IntelyCare, we're empowering healthcare heroes to transform the way they work. IntelyCare simplifies the scheduling and staffing process to match qualified nursing professionals like you with shifts at our nursing facilities. Available shift options include per-diem, contract, short-term, long-term, temporary to permanent and in some cases, travel. With IntelyCare, you'll get the pay, freedom, and flexibility you deserve--all from one intelligent and easy-to-use mobile app.

Industry

Recruiting and staffing services

Company size

10,000+ Employees

Headquarters location

Quincy, MA, US

Year founded

2014

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