RN Utilization Management - Evening Care Optimization

Summa Health; Akron (OH); On-site; USD 78,000 - 117,000; Full time

Job summary

Summa Health in Akron, OH is seeking an RN Utilization Management professional for a full-time shift 4:00pm–12:30am. The role focuses on cost-effective utilization across the care continuum, aligning with clinical outcomes and payer guidelines.

You will perform initial and concurrent reviews to obtain authorizations for acute care, collaborate with the Transitional Care Team and Physician Advisors, and support denial appeals and appeals with payers.

Qualifications

• Associate's degree in Nursing (ADN) is required; BSN preferred.
• Graduate of CCNE or ACEN accredited program.
• Current Ohio RN license to practice.

Responsibilities

• Perform initial and concurrent clinical reviews to capture authorization for acute care.
• Collaborate with Transitional Care Team, Physician Advisors, Providers and department leadership to manage patient status.
• Support appeal of payer denials in collaboration with internal RN teams and external advisers.

Skills

Clear communication

Data analysis

Independent work

Population care

Insurance industry knowledge

Education

Associate's degree in Nursing (ADN)

BSN preferred

CCNE/ACEN accredited program

Job description

Summa Health in Akron, OH is seeking an RN Utilization Management professional for a full-time shift 4:00pm–12:30am. The role focuses on cost-effective utilization across the care continuum, aligning with clinical outcomes and payer guidelines.

You will perform initial and concurrent reviews to obtain authorizations for acute care, collaborate with the Transitional Care Team and Physician Advisors, and support denial appeals and appeals with payers.