Manager/Utilization Review Nurse - Part Time

Wilson Health • Sidney, OH

39d • Onsite

About The Position

Wilson Health is seeking an experienced Registered Nurse (RN) to join our Case Management team in a part-time capacity. The Case Management RN plays an important role in coordinating patient care, supporting safe and timely discharge planning, ensuring appropriate utilization of healthcare resources, and promoting positive patient outcomes throughout the continuum of care. This position works collaboratively with physicians, nursing, ancillary departments, patients, families, payers, and community resources to identify patient needs, coordinate services, address barriers to discharge, and support appropriate levels of care. The Case Management RN also assists with utilization review, clinical documentation, medical necessity reviews, and inpatient denial prevention and management.

Requirements

• Current, active, unrestricted Registered Nurse (RN) license in the State of Ohio required.
• Strong clinical assessment and critical-thinking skills.
• Knowledge of utilization review and medical necessity principles.
• Understanding of discharge planning and transitions of care.
• Ability to effectively coordinate services across multiple disciplines.
• Strong communication, organization, and problem-solving skills.
• Ability to communicate effectively with patients, families, physicians, clinical staff, payers, and community partners.
• Ability to identify barriers to care and develop appropriate solutions.
• Strong attention to documentation, regulatory requirements, and patient confidentiality.
• Ability to prioritize responsibilities and manage multiple patient needs in a fast-paced healthcare environment.

Nice To Haves

• Graduate of an accredited school of nursing required. Bachelor of Science in Nursing (BSN) preferred.
• Previous Case Management, Utilization Review, Discharge Planning, or acute-care nursing experience strongly preferred.
• Strong knowledge of utilization review, medical necessity, discharge planning, and coordination of care preferred.
• Experience working collaboratively with physicians, nursing, Revenue Cycle, payers, and community resources is beneficial.
• Case Management certification through ACMA, CMSA, or another recognized case management organization preferred.

Responsibilities

• Perform utilization review activities to evaluate the appropriateness of admission, continued hospital stay, level of care, clinical documentation, and applicable standards of care.
• Assess patients for physical, psychological, functional, social, environmental, and financial needs that may affect their plan of care or discharge.
• Develop and coordinate individualized discharge plans in collaboration with patients, families, physicians, nursing, ancillary departments, and community providers.
• Identify potential barriers to discharge and proactively coordinate resources and services to support safe and timely transitions of care.
• Review treatment plans and available alternatives and assist in coordinating the most appropriate plan of care.
• Participate in multidisciplinary rounds and collaborate with the healthcare team regarding patient progression and discharge readiness.
• Serve as a resource to physicians, nursing, and ancillary staff regarding utilization management, estimated length of stay, avoidable hospital days, quality measures, and discharge planning needs.
• Facilitate appropriate physician documentation to support medical necessity, severity of illness, risk of mortality, complexity of care, and applicable best-practice standards.
• Refer appropriate cases to the Utilization Review Physician Advisor.
• Assist with inpatient medical necessity denials and appeals and collaborate with Revenue Cycle to identify opportunities to reduce preventable denials.
• Perform case reviews and audits to promote consistency with standards of care, documentation requirements, and appropriate utilization of services.
• Assist with data collection, analysis, reporting, and identification of opportunities for Case Management process improvement.
• Participate in continuous quality improvement initiatives throughout Wilson Health.
• Coordinate with outside agencies, post-acute providers, suppliers, and family members as necessary to support successful patient outcomes and transitions of care.
• Maintain accurate and timely documentation of Case Management activities.
• Manage an assigned patient caseload as determined by department needs.
• Maintain professional knowledge and participate in ongoing education and professional development.
• Perform additional duties as assigned within the scope of the position.

Benefits

• Access to Employer Direct Care Clinic. Free medical care and pharmacy services for eligible employees and dependents covered by Wilson Health's medical insurance plan.
• Generous paid time off (PTO) program beginning day one, designed to support work-life balance, rest, and time with family.
• Medical Insurance: Choose from two High - Deductible Health Plan (HDHP) options or a PPO plan, along with Dental and Vision coverage. Benefits begin on the first of the month following your hire date.
• HSA with employer contribution for eligible health plans; FSA for medical and dependent care expenses.
• Company-paid Life Insurance and Long-Term Disability Insurance
• Voluntary Accident, Critical Illness, and employee and dependent Life and AD&D Insurance.
• Industry-leading retirement plan – employer contributions begin day one with no waiting period for participation.
• Tuition Assistance Program
• Free access to an on-site gym, available 24/7, making it easy to prioritize your health and wellness before or after your shift.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level