Utilization Review Nurse (RN) – Drive Care & Compliance

Wilson-Health; Buckeye Terrace (OH); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

On-site clinic

Generous PTO

Medical insurance

HSA/FSA

Life insurance

Disability insurance

Tuition assistance

On-site gym

Retirement plan

Job summary

Wilson Health is hiring a Utilization Review Nurse (RN) for a full-time role in Ohio. The UR RN conducts prospective, concurrent, and retrospective reviews to ensure appropriate utilization of hospital services and compliance with payer and regulatory requirements.

Collaborative with physicians, case management, and leadership to support patient placement and documentation. The position emphasizes accurate documentation, denial prevention, and knowledge of Medicare/Medicaid requirements, with a

Qualifications

• Current, unrestricted RN license in Ohio.
• Graduation from an accredited nursing program.
• Clinical nursing experience with strong assessment/critical-thinking skills.
• Working knowledge of medical terminology and standards of care.
• Proficient with electronic medical records and basic computer applications.

Responsibilities

• Perform medical necessity and level-of-care reviews for inpatients, observation, emergencies, and other services.
• Review clinical documentation, orders, and progress to determine admission/continued stay appropriateness.
• Apply UR criteria, payer guidelines, Medicare requirements, and hospital policies.
• Identify cases not meeting criteria and communicate concerns to physicians and care team.
• Facilitate peer-to-peer reviews with payers when necessary.
• Monitor patients during hospitalization and identify discharge barriers.

Skills

Critical thinking

Clinical assessment

Communication skills

EMR systems

Education

RN license (OH)

Accredited nursing program

Tools

EMR software

Job description

Wilson Health is hiring a Utilization Review Nurse (RN) for a full-time role in Ohio. The UR RN conducts prospective, concurrent, and retrospective reviews to ensure appropriate utilization of hospital services and compliance with payer and regulatory requirements.

Collaborative with physicians, case management, and leadership to support patient placement and documentation. The position emphasizes accurate documentation, denial prevention, and knowledge of Medicare/Medicaid requirements, with a