Utilization Case Manager (RN)

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Job Title:

Department:

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 Qualifications

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

Additional Information:

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Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions.

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