RN Lead: Acute & Post-Acute Utilization Mgmt (Hybrid)

Medical Mutual; Cleveland (OH); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Laptop provided

On-site fitness center

On-site cafeteria

Employee discounts

Cash rewards program

Business casual attire

Job summary

Medical Mutual in Brooklyn, OH is seeking a Nursing Supervisor to oversee utilization staff, ensuring medical necessity guidelines are applied for inpatient, concurrent, and retrospective reviews. You will collaborate with physician reviewers to support safe discharges and timely care transitions.

The role requires an Ohio RN license, with BSN preferred, and 7+ years in utilization review with leadership experience. Hybrid onsite three days per week in Brooklyn, OH.

Qualifications

• RN license in good standing with Ohio; Bachelor's degree preferred.
• 7+ years of progressive RN experience in utilization review or case management.
• Experience leading teams or projects within health insurance/utilization management.

Responsibilities

• Oversee daily operations of utilization staff and drive performance and engagement.
• Facilitate collaboration across disciplines for utilization management and discharge planning.
• Ensure data collection for authorizations and monitor performance and timeliness.
• Maintain compliance with policy, procedures, and regulatory standards.
• Support onboarding, training, and professional development of staff.

Skills

Leadership

Change management

Data analysis

Discharge planning

Education

RN licensure (OH)

BSN preferred

Healthcare Administration knowledge

Tools

Microsoft Office

ICD-10/CPT/HCPCS

Healthcare systems knowledge

Claims management systems

Job description

Medical Mutual in Brooklyn, OH is seeking a Nursing Supervisor to oversee utilization staff, ensuring medical necessity guidelines are applied for inpatient, concurrent, and retrospective reviews. You will collaborate with physician reviewers to support safe discharges and timely care transitions.

The role requires an Ohio RN license, with BSN preferred, and 7+ years in utilization review with leadership experience. Hybrid onsite three days per week in Brooklyn, OH.