Director of Utilization Review & Payer Strategy

Cincinnati Children's Hospital Medical Center; Cincinnati (OH); On-site; USD 130,000 - 169,000; Full time

Job summary

Cincinnati Children's seeks a Utilization Review Manager to lead UR operations, ensuring appropriate inpatient approvals and compliance with payer requirements. You will coordinate with payers, support appeals, and drive UR programs that align with clinical needs and hospital goals.

Ideal candidates have RN licensure in Ohio, a nursing degree, and several years in UR/UM with leadership experience, contributing to financial stewardship and quality care.

Qualifications

• Bachelor's degree in nursing is required.
• 5+ years of related work experience in UR/UM or equivalent.
• 4 years frontline management experience required.
• Active RN license in Ohio required.

Responsibilities

• Utilization Review Management—lead UR to ensure payer approvals for inpatient admissions and continued stays.
• Revenue Cycle Support—interact with Medicaid/Medicare and third-party reviewers; assist with denials.
• Payer Relations—build and maintain relationships with payers and employers; present Cincinnati Children's.
• Financial Management—manage annual operating expense budgets for departments.

Skills

5+ years of work experience in a UR/UM

4 years frontline management

Education

Bachelor's degree in nursing

Active RN License in Ohio

Job description

Cincinnati Children's seeks a Utilization Review Manager to lead UR operations, ensuring appropriate inpatient approvals and compliance with payer requirements. You will coordinate with payers, support appeals, and drive UR programs that align with clinical needs and hospital goals.

Ideal candidates have RN licensure in Ohio, a nursing degree, and several years in UR/UM with leadership experience, contributing to financial stewardship and quality care.