Utilization Management Nurse

University Hospitals

. Perform timely and accurate admission and continued-stay reviews according to department policy .

Posted 10/6/2026part-timeRemote • Ohio • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical reviews, utilization management, and patient care coordination, ensuring compliance with healthcare regulations and standards. Proficient in documentation, communication, and analytical skills to support positive patient outcomes and efficient resource use.

Highest-signal resume keywords

Registered Nurse (RN)Clinical Experience in Acute CareUtilization Management ExperienceKnowledge of Medicare and Medicaid RegulationsExperience with InterQual or MCG Criteria

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewPatient Care CoordinationDocumentationAnalytical SkillsProblem-SolvingDetail-OrientedCritical ThinkingResource ManagementTimely AuthorizationLength of Stay Management

Soft Skills

Strong Communication SkillsTeam PlayerOrganizational SkillsAbility to Function Independently

Tools & Technologies

Microsoft Office SuitePCsGeneral Office Equipment

Certifications & Qualifications

Registered Nurse (RN) LicenseCM Certificate

Industry Keywords

Acute CareSub-Acute SettingManaged CarePayer DecisionsProtected Health Information

About the role

Key responsibilities & impact

Perform timely and accurate admission and continued-stay reviews according to department policy
Ensure efficient use of hospital resources, timely discharge, and appropriate reimbursement
Communicate with internal and external customers regarding clinical reviews
Coordinate with healthcare team members, patients, and families on level-of-care and payer decisions
Document review activity, criteria or policy application, clinical reviews, registration changes, outcomes, and cost savings
Meet department productivity and quality standards
Support positive patient outcomes, inpatient throughput, appropriate length of stay, continuity of care, timely authorization, and reduced denials
Perform other assigned duties
Comply with policies, standards, and protected health information requirements

Requirements

What you’ll need

Graduate of an accredited school of Nursing (Required)
3+ years of clinical experience in acute care (Required)
2+ years of clinical experience with the population to be served (Required)
Registered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire)
Sound clinical knowledge base of the population to be served
Detail-oriented and organized, with analytical/critical thinking and problem-solving skills
Ability to function independently and as a team player in a fast-paced environment
Strong written and verbal communication skills
Ability to use PCs, Microsoft Office suite, and general office equipment
Ability to apply concepts, utilize sound judgment, and work independently within guidelines
Additional experience in sub-acute setting or managed care (Preferred)
Prior utilization management experience (Preferred)
Experience with InterQual or MCG criteria (Preferred)
Knowledge of Medicare, Medicaid, and commercial payer regulations (Preferred)
CM certificate (Preferred)

Benefits

Comp & perks

Part-time regular employment
Day shift
Remote work
No travel