Remote 
Utilization Case Management - RN Specialist 2
 Ohio State University Wexner Medical Center | |
 United States, Ohio | |
 Feb 26, 2025 | |
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Job Description Scope of Position / Position Summary: 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. Minimum Education Required Bachelor's Level Degree or equivalent combination of education and experience with a Major in nursing Required Qualifications Bachelor's degree in Nursing preferred, public health, allied health, or other clinically related field. Three to five years of Case Management and/or Utilization Management experience required.
Position schedule is Saturday, Sunday, Monday, Tuesday | |