Clinical Financial Case Manager, RN

The Ohio State University, Main Campus

. Support the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center .

Posted 11/10/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical operations, utilization management, and payer requirements while effectively collaborating with multidisciplinary teams. Proficient in analyzing complex clinical information and applying medical necessity guidelines to ensure appropriate patient care and compliance.

Highest-signal resume keywords

Bachelor's Degree In NursingClinical Care ExperienceUtilization ManagementAnalytical SkillsProficiency In Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical OperationsMedical Necessity GuidelinesPayer RequirementsClinical Documentation ImprovementRevenue ManagementCodingPatient FlowMultitaskingTyping SkillsProblem-Solving

Soft Skills

CollaborationCommunicationAdaptabilityDecision-MakingContinuous Learning

Tools & Technologies

IHISMicrosoft Office ProductsAdobe ProfessionalEmailInternet BrowsersSharePointTeamsOneNoteFax MachinesCopy Machines

Certifications & Qualifications

Current Nursing License

Industry Keywords

Healthcare TrendsJCAHOCMSUtilization Management GuidelinesRACMACQIOClinical WorkflowsFinancial CounselingPayer Websites

About the role

Key responsibilities & impact

Support the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center
Function within a multidisciplinary team to secure complex pre-authorizations and prevent or appeal clinical denials
Use clinical knowledge to interpret and apply medical necessity guidelines
Determine the appropriateness of services provided
Determine the appropriate level of care, including Inpatient or Observation, by interpreting documented clinical information
Become a subject matter expert for assigned payers and governmental payer requirements and audits, including RAC, MAC, and QIO
Maintain awareness of state and national healthcare trends, JCAHO, CMS, and third-party payer Utilization Management guidelines
Acquire and apply knowledge across managed care, scheduling, financial counseling, pre-certification, admissions/discharges/transfers, clinical workflows and documentation, revenue management, coding, medical information management, case management, utilization management, clinical documentation improvement, compliance, legal, finance, transplant workflows, billing, follow-up, and cash posting
Read and interpret payer remits, denial/remark codes, and expected reimbursement
Determine the cost-effectiveness of completing an appeal
Troubleshoot, problem-solve, continuously learn, and adapt to changing payer rules
Work independently and collaboratively with Legal, Medical Information Management, physician groups, and the Business Office

Requirements

What you’ll need

Bachelor’s degree in nursing with current license required
Minimum of 2 years clinical care experience
Experience collaborating with physicians and their designees
Strong, proven analytical skills and ability to make educated decisions
Extensive knowledge of clinical operations and patient flow
Ability to synthesize large volumes of information and communicate concisely verbally or in writing
Proficiency in Microsoft Office products, including Word, PowerPoint, Excel, SharePoint, Teams, and OneNote
Proficiency in Adobe Professional
Proficiency using email, fax machines, copy machines, and internet browsers
Proficient typing skills
Proficiency in technology, computer, and web applications
Ability to multitask and move quickly between multiple applications
Ability to orient oneself to new applications quickly
Ability to manage multiple applications, including IHIS, MS Office products, 3M, and payer websites/applications
Successful completion of a background check
Drug screen or physical may be required during the post-offer process

Benefits

Comp & perks

Regular position
40 scheduled hours per week
First shift
Remote work arrangement