The Ohio State University Wexner Medical Center
The Utilization Management Case Manager (UM CM) implements and supports the philosophy, mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center. The UM CM contributes to the hospitals Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines. The UM CM maintains an awareness of State and National health care trends, JCAHO, CMS and third party payor Utilization Management guidelines. Additional Information: Position schedule is Saturday, Sunday, Monday, Tuesday
Bachelor's Level Degree or equivalent combination of education and experience with a Major in nursing Required Qualifications Bachelor's degree in Nursing preferred, public health, allied health, or other clinically related field. Three to five years of Case Management and/or Utilization Management experience required.
Basic
Telehealth
$34
Resume Template Package
ATS optimized design for nurses
Matching Cover Letter
Matching Reference Page
Resume Tips and Tricks
ADVANCED
Telehealth
$79
Everything from Starter Pack
Resume Optimization Guide
7 Nurse Resume Examples
20+ Professional Summary Examples
How to Structure Unique Career Experiences
BEST VALUE
Telehealth
$149
Everything from Starter Pack
Everything from Pro Toolkit
Career Accelerator Success Guide
Proven method for landing your dream role
Lifetime Premium Job Board Access
Application Tracker
1:1 Expert Support