RN Utilization Management Lead

Ohio Department of Public Safety; Columbus (OH); On-site; USD 90,000 - 95,000; Full time

Job summary

Ohio Department of Medicaid seeks a RN Utilization Management Section Chief to lead clinical operations and drive quality across programs. You will work under clinical direction to oversee UM processes, reports, and vendor management within the Health Innovation & Quality Office.

The role requires a registered nurse license in Ohio, a graduate degree in a health-related field, and 2 years of health services management experience.

Qualifications

• Graduate degree in health administration, public health, business or public administration.
• 24 months experience in planning or administering health services programs or health services project management.
• Current and valid RN license in Ohio.

Responsibilities

• Oversee UM clinical operations, technology, quality and regulatory oversight to advance ODM objectives.
• Manage two teams of nurses and oversee UM of vendor and managed care entities.
• Develop reports to monitor goals of overall utilization management across ODM programs.
• Oversee day-to-day operational activities of the Utilization Management Program.
• Develop and maintain policies and procedures for authorization processes and monitoring.

Skills

Nursing

Health Administration

Collaboration

Critical Thinking

Decision Making

Leading Others

Education

Graduate degree in health administration / public health / business or public administration

Job description

Ohio Department of Medicaid seeks a RN Utilization Management Section Chief to lead clinical operations and drive quality across programs. You will work under clinical direction to oversee UM processes, reports, and vendor management within the Health Innovation & Quality Office.

The role requires a registered nurse license in Ohio, a graduate degree in a health-related field, and 2 years of health services management experience.