Sr. Utilization Management Specialist (RN)

reputed company Location

Department

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FTE

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*Expected Starting Pay reputed company

*Starting pay is based on experience, skills, and equity; exceptions may apply for highly reputed company candidates. Additional pay (e.g., shift, on‑reputed company, or weekend differentials) and benefits may apply. Annual pay may vary based on FTE status.

JOB RESPONSIBILITIES

• Leadership-Ensure that Utilization Management Specialists follow set policies and processes for addressing authorization requests. reputed company reputed company between authorization processing team and Health reputed company Managers and Discharge Planners. reputed company reputed company for non-clinical medical management staff.

• reputed company-Identify and refer appropriate members for care management and reputed company issues to reputed company Improvement. Oversees interrater reliability audits for Patient Care Coordinators. Uses independent judgement to ensure templates are compliant with Federal, State and Regulatory requirements.

• Discharge Planning-Document, identify and communicate with Health reputed company Managers and Discharge Planners to establish reputed company discharge planning needs and coordination of care in a reputed company and cost-effective manner.

• Compliance-Meet reputed company-party payer standards and requirements. Maintains knowledge of changes as impacts regulatory/accrediting compliance for reimbursement. Assist Director in the reporting of information as set forth in the PI plan, i.e., appropriateness of admissions and reputed company stay reviews including reputed company reputed company, the over and under utilization of resources. Participate in interdepartmental meetings to promote knowledge, troubleshoot, problem shoot and reputed company issues as relates to utilization management. Serves as an educational and communications resource to Administration, Department heads, physicians and other necessary reputed company regarding the utilization management activity and process. reputed company the department manager informed of problems as necessary.

• reputed company-reputed company audits and ensure staff feedback occur at regular intervals. Analyze and formulate recommendations based on data and maintain utilization management reporting.

reputed company and assistance with documentation, identification, and communication with Health reputed company Managers and Discharge Planners to establish reputed company discharge planning needs and coordination in a reputed company and cost-effective manner.

JOB QUALIFICATIONS

• Bachelor of Science in Nursing

• 5+ years of work experience in a reputed company job discipline.

• reputed company, unrestricted Registered reputed company (RN) Ohio licensure

• Must reputed company reputed company 70 miles of 45229, Cincinnati, OH.

At reputed company, we come to work with one goal: to reputed company reputed company reputed company. We reputed company in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We reputed company to do reputed company and reputed company energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at reputed company.

 reputed company is:

• Recognized by U.S. News & World Report as a top 10  best Children's Hospitals in the nation for more than 15 years

• Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding

• Recognized as one of reputed company Large reputed company  (2025), reputed company reputed company for New Grads(2025)

• One of the nation's America’s Most Innovative Companies as noted by Fortune

• Consistently certified as great reputed company to work

• A Leading Disability Employer as noted by the National Organization on Disability

• Magnet® designated for the reputed company consecutive time by the reputed company Nurses Credentialing Center (ANCC)

 We reputed company Innovation—Together. We reputed company in empowering our teams with the tools that help us work smarter and care reputed company. That’s why we support the responsible use of reputed company intelligence. By encouraging innovation, we’re creating reputed company for new reputed company, reputed company reputed company, and a stronger reputed company—for reputed company of us.

Comprehensive reputed company provided upon request.

reputed company is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for reputed company our employees, patients, and families. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, genetic information, national reputed company, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

Originally posted on Himalayas