Remote Utilization Review Specialist

CO00 Children's Hospital Medical Center; United States; Remote; USD 69,000 - 89,000; Full time

Job summary

Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity and certification for inpatient stays. The role requires RN licensure with relevant experience and works remotely in the United States.

The position includes interactions with admitting, financial counseling, and care teams to ensure proper authorization, documentation, and discharge planning aligned with payer requirements.

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 certification of admission.
• Document all required information and maintain records in computerized systems.
• Interface with Admitting and Financial Counseling to identify insurance, coverage dates, and authorizations.
• Coordinate with care team on discharge planning and payer requirements; communicate to third party payers for inpatient stays.

Skills

RN Licensure

Payers experience

Communication skills

Education

Bachelor's degree in a related field

Job description

Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity and certification for inpatient stays. The role requires RN licensure with relevant experience and works remotely in the United States.

The position includes interactions with admitting, financial counseling, and care teams to ensure proper authorization, documentation, and discharge planning aligned with payer requirements.