Inpatient Utilization Review RN & Discharge Planning

Quantum Health, Inc.; Dublin (OH); On-site; USD 52,000 - 103,000; Full time

Job summary

Quantum Health, Inc. in Dublin, OH is seeking an Utilization Review Nurse to assess and process inpatient medical service requests for employer-group members, ensuring alignment with plan language and criteria.

You will collaborate with providers and facilities to support discharge planning and deliver high‑quality clinical reviews within required timeframes. The role emphasizes independent decision‑making, strong communication with patients and providers, and utilization management across care

Qualifications

• Active, unrestricted RN license or equivalent in good standing
• Minimum 2 years of direct patient care in an inpatient setting
• Experience in health management preferred
• Ability to work independently with limited supervision
• Strong verbal and written communication skills

Responsibilities

• Assess and review inpatient requests against plan language and clinical criteria.
• Conduct initial, concurrent, and retrospective clinical reviews.
• Document outcomes in the authorization database.
• Coordinate discharge planning and post-discharge arrangements.
• Communicate with patients, providers, facilities, and internal teams.
• Prepare and present high-quality medical reviews for MD review.

Skills

RN license

Inpatient care

Critical thinking

Communication

Microsoft Office

Tools

Microsoft Office

Job description

Quantum Health, Inc. in Dublin, OH is seeking an Utilization Review Nurse to assess and process inpatient medical service requests for employer-group members, ensuring alignment with plan language and criteria.

You will collaborate with providers and facilities to support discharge planning and deliver high‑quality clinical reviews within required timeframes. The role emphasizes independent decision‑making, strong communication with patients and providers, and utilization management across care