Remote Utilization Review RN | Case Management Expert

cincinnatichildrens; United States; Remote; USD 69,000 - 88,000; Full time

Job summary

Cincinnati Children's is seeking an experienced Utilization Review professional for a remote, full-time role in the United States. The position focuses on case management, inpatient authorization, and compliance with payer requirements to optimize patient care and resource use.

The ideal candidate holds an RN, Social Work, or Clinical Counselor license and has 2+ years of related experience, with preferred familiarity in payer programs.

Qualifications

• Bachelor's degree in a related field.
• 2+ years of work experience in a related job discipline.
• Current, unrestricted RN, Social Work or Clinical Counselor Licensure in the state(s) of practice.
• Preferred: Experience with Payers (Commercial and Government).

Responsibilities

• Case Management: Perform admission and continued stay reviews to determine medical necessity and intensity of service for certification of admission and continued stay.
• Authorization Process: Facilitate interaction between medical center personnel and payer personnel to overturn potential denials and obtain reimbursement.
• Compliance: Assist in meeting regulatory and accrediting standards and in reporting information related to utilization review.
• Training & Education: Serve as an educational resource regarding Utilization Review to administration, department heads, physicians, and other groups.

Education

Bachelor's degree in a related field

Job description

Cincinnati Children's is seeking an experienced Utilization Review professional for a remote, full-time role in the United States. The position focuses on case management, inpatient authorization, and compliance with payer requirements to optimize patient care and resource use.

The ideal candidate holds an RN, Social Work, or Clinical Counselor license and has 2+ years of related experience, with preferred familiarity in payer programs.