Utilization Case Manager (RN)

The Ohio State University

6d • Remote

About The Position

The Utilization Management Case Manager (UM CM) implements and supports the philosophy, mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center. The UM CM contributes to the hospitals Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines. The UM CM maintains an awareness of State and National health care trends, JCAHO, CMS and third party payor Utilization Management guidelines.

Requirements

• Bachelor’s degree, Masters preferred.
• RN licensure required.
• Three years of Case Management and/or Utilization Management experience required.

Nice To Haves

• In-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines.

Responsibilities

• Implement and support the philosophy, mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center.
• Contribute to the hospitals Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care.
• Maintain an awareness of State and National health care trends, JCAHO, CMS and third party payor Utilization Management guidelines.

Benefits

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
• Paid time off, including sick and vacation time and 11 holidays.
• State retirement plan or an alternative retirement plan, both with generous employer contributions.

What This Job Offers

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