Ohio Licensed Utilization Care Manager

Job Summary

A company is looking for a Utilization Care Manager (RN).

Key Responsibilities

• Determine appropriateness for inpatient level of care or observation services using medical necessity guidelines
• Apply various payer rules, regulations, and MCG guidelines in compliance with CMS guidelines
• Maintain awareness of State and National health care trends and Utilization Management guidelines

Required Qualifications

• Bachelor's degree in Nursing preferred, or in public health, allied health, or other clinically related field
• Two years of Care Management and/or Utilization Management experience required