Utilization Care Manager - Rn

The Ohio State University

Remote, , US
Fully remote
Medical necessity guidelines
Payer rules and regulations
Inpatient level of care determination
The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services

Job Summary

  • The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services.
  • This role requires in-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines.
  • The UCM maintains an awareness of State and National health care trends, TJC, CMS and third party payor Utilization Management guidelines.

Matching Summary

The Utilization Care Manager contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services.

Skills & Requirements

Must-have

  • medical necessity guidelines
  • payer rules and regulations
  • inpatient level of care determination

Nice-to-have

  • awareness of healthcare trends
  • team collaboration
  • patient advocacy

Key Requirements

  • Bachelor's degree in Nursing
  • RN licensure
  • Two years Care Management experience
  • Two years Utilization Management experience

Work Rights

Not specified

Tailored Resume

Cover Letter