RN Utilization Management — Drive Cost-Effective Care

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

Benefits offered by this job

Medical, dental, vision

Job summary

Summa Health is seeking an RN in Utilization Management at Barberton Hospital to perform initial and concurrent reviews for authorization of acute care. The role collaborates with Transitional Care and physician advisors to ensure appropriate patient disposition under Medicare guidelines.

Minimum qualifications include ADN (BSN preferred) and Ohio RN license, with at least 2 years in acute care or managed care. Strong communication and data analysis skills are required.

Qualifications

• Requires ADN and Ohio RN licensure with CCNE/ACEN-accredited education.
• BSN preferred; strong understanding of payer rules and regulations.
• Ability to review and interpret clinical data for utilization management.

Responsibilities

• Perform initial and concurrent clinical reviews for authorization.
• Collaborate with Transitional Care Team and physicians on patient status.

Skills

Communication skills

Data analysis

Clinical population expertise

Independent prioritization

Population-specific competency

Insurance industry knowledge

Education

ADN required

BSN preferred

Ohio RN license

Job description

Summa Health is seeking an RN in Utilization Management at Barberton Hospital to perform initial and concurrent reviews for authorization of acute care. The role collaborates with Transitional Care and physician advisors to ensure appropriate patient disposition under Medicare guidelines.

Minimum qualifications include ADN (BSN preferred) and Ohio RN license, with at least 2 years in acute care or managed care. Strong communication and data analysis skills are required.