RN Utilization Management: Care Outcomes Advocate

Summa Health; Barberton (OH); On-site; USD 52,000 - 77,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life Insurance

PTO + Paid Leave

Retirement Savings Plan

Flexible Spending Accounts

EAP

Identity Theft Protection

Pet Insurance

Education Assistance

Daily Pay

Job summary

Summa Health System is seeking an RN for Utilization Management at Barberton Hospital. This full-time day position focuses on cost-effective care across the continuum and requires a current Ohio license with relevant acute care or managed care experience.

The role involves clinical reviews, collaboration with physicians and care teams, and ensuring compliance with Medicare and payer guidelines. Summa offers competitive pay and comprehensive benefits.

Qualifications

• Associate degree in Nursing (ADN) required, BSN preferred.
• Experience in Utilization Management concepts including Medicare/Regulatory guidelines.
• Current Ohio RN license and 2+ years in acute care or managed health care setting.

Responsibilities

• Manage cost-effective utilization of services across the care continuum.
• Perform initial and concurrent clinical reviews for admissions and transitions.
• Collaborate with care teams to determine patient status and ensure compliance with payer guidelines.

Skills

Communication skills

Data analysis

Clinical expertise

Independent work

Population-specific needs

Insurance knowledge

Education

Associate's degree in Nursing (ADN)

BSN preferred

Job description

Summa Health System is seeking an RN for Utilization Management at Barberton Hospital. This full-time day position focuses on cost-effective care across the continuum and requires a current Ohio license with relevant acute care or managed care experience.

The role involves clinical reviews, collaboration with physicians and care teams, and ensuring compliance with Medicare and payer guidelines. Summa offers competitive pay and comprehensive benefits.