Utilization Review RN - Inpatient Care & Discharge

Quantum Health; Dublin (OH); On-site; USD 52,000 - 103,000; Full time

Job summary

Quantum Health, a leading healthcare navigation company in Central Ohio, is hiring an Utilization Review Nurse for its Dublin, OH campus. The role reviews inpatient medical services against plan language, coordinates discharge planning, and collaborates with providers to ensure cost-effective, medically necessary care.

Candidates must hold an active clinical license (RN/LPN) with at least two years of inpatient experience and be able to work within fast-paced, cross-functional teams.

Qualifications

• Active, unrestricted professional license in a clinical discipline (RN/LPN or eligible).
• Minimum 2 years of inpatient clinical experience.

Responsibilities

• Assess inpatient requests for medical services and perform initial, concurrent, and retrospective reviews.
• Make independent determinations following Quantum Health workflows.
• Document outcomes in the authorization database and coordinate discharge planning.
• Communicate with patient, providers, facilities and internal teams about review results.
• Redirect out-of-network requests to in-network to maximize member benefits.
• Prepare high-quality medical reviews for MD collaboration and decision.

Skills

RN licensure

LPN licensure

Clinical review

Discharge planning

Tools

Microsoft Office

Teams

Zoom

Job description

Quantum Health, a leading healthcare navigation company in Central Ohio, is hiring an Utilization Review Nurse for its Dublin, OH campus. The role reviews inpatient medical services against plan language, coordinates discharge planning, and collaborates with providers to ensure cost-effective, medically necessary care.

Candidates must hold an active clinical license (RN/LPN) with at least two years of inpatient experience and be able to work within fast-paced, cross-functional teams.