Utilization Case Manager, RN

This is a fully remote position, open to applicants in United States.

📋 Description

• Executes and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.

• Aids in the hospital's Utilization Management Program Plan by applying medical necessity guidelines to assess the suitability for inpatient care or observation services based on documented clinical information, ensuring compliance with CMS guidelines and other payer requirements concerning the appropriate level of care.

• Remains informed about State and National healthcare trends, as well as JCAHO, CMS, and third-party payer Utilization Management guidelines.

⛳️ Requirements

• Bachelor’s degree; a Master's is preferred.

• RN licensure is mandatory.

• A minimum of three years of experience in Case Management and/or Utilization Management is required.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage, with a significant portion of the cost covered by Ohio State.

• Paid time off that includes sick leave, vacation time, and 11 holidays.

• A state retirement plan or an alternative retirement plan, both featuring generous employer contributions.