RN Utilization & Care Management Specialist

Southwest General; Middleburg Heights (OH); Hybrid; USD 80,000 - 110,000; Full time

Job summary

Southwest General is seeking an Utilization Specialist to conduct admission and concurrent stay screening reviews for eligible patients within the episode of care. The role ensures appropriate services, efficient resource use, and quality of care under guidelines.

Required are BSN or higher, five years of clinical nursing or related experience, and familiarity with screening criteria such as Interqual or MCG. Strong critical thinking and communication skills are essential.

Qualifications

• Graduation from an accredited School of Nursing. BSN graduate preferred.
• Minimum of five (5) years recent experience in clinical nursing or related nursing field (e.g. Utilization Review or Case Management).
• Previous Care Management, Case Management or Utilization Management Experience preferred
• Previous experience with screening criteria (i.e. Interqual, MCG) preferred
• Excellent critical thinking and communication skills

Responsibilities

• Carries out admission and concurrent stay screening reviews of assigned patients.
• Identify and support patients being placed in appropriate hospital level of care via admission processes.
• Communicate with physicians, hospital staff, insurance companies and patients regarding level of care and resource utilization.

Skills

Critical thinking

Communication

Education

BSN preferred

Bachelor's degree in Nursing

Job description

Southwest General is seeking an Utilization Specialist to conduct admission and concurrent stay screening reviews for eligible patients within the episode of care. The role ensures appropriate services, efficient resource use, and quality of care under guidelines.

Required are BSN or higher, five years of clinical nursing or related experience, and familiarity with screening criteria such as Interqual or MCG. Strong critical thinking and communication skills are essential.