RN Utilization Rvw Spclst - Utilization Management
ketteringhealth
RN Utilization Rvw Spclst - Utilization Management
ketteringhealth· 705493 - UTILIZATION MGMT
About this role
Job Details
Utilization Management | Miamisburg | Part-time | Varied Shift
Responsibilities & Requirements
- Registered professional nurse with education, knowledge and experience.
- Role focuses on review of inpatient and observation admissions to ensure correct assignment of Admit status.
- Communicates concurrently and resolves medical necessity discrepancies with physicians and other hospital leadership as needed.
- Responsible for completing clinical review on all assigned patients and communicates these reviews to payers.
- Identifies potential or actual denials for admission or ongoing stay both during the patient’s hospital stay and post discharge.
- Review and decide the validity of medical necessity payer denials. Submits payer denial appeals.
- Participates in design of work flows and procedure to reduce incidence of denials.
- Current unrestricted Ohio RN licensure, BSN required.
- Experience with computers required.
Preferred Qualifications
- 5 years clinical experience with 2 years case management
- Case Management certification
- Works independently
- Familiar with MCG Care guidelines
- Ability to adapt quickly to changing priorities and regulations
- Experience with Microsoft applications and EPIC software
! WEEKEND ONLY!
Overview
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.
Frequently Asked Questions
Is the salary disclosed for the RN Utilization Rvw Spclst - Utilization Management position at ketteringhealth?
The salary for this RN Utilization Rvw Spclst - Utilization Management role at ketteringhealth is not publicly listed. Click "Apply Now" to learn more about the compensation package on their official careers page.
Where is the RN Utilization Rvw Spclst - Utilization Management position at ketteringhealth located?
This RN Utilization Rvw Spclst - Utilization Management role at ketteringhealth is based in Miamisburg, OH, US. The position is listed as on-site or hybrid. Check the full job description or apply directly to confirm the work arrangement.
Is the RN Utilization Rvw Spclst - Utilization Management role at ketteringhealth full-time or part-time?
This is listed as a PART TIME position. It is posted as a RN Utilization Rvw Spclst - Utilization Management role in the 705493 - UTILIZATION MGMT department at ketteringhealth.
Which team or department does the RN Utilization Rvw Spclst - Utilization Management at ketteringhealth belong to?
This RN Utilization Rvw Spclst - Utilization Management position is part of the 705493 - UTILIZATION MGMT department at ketteringhealth. See the full job description for more information about the team structure and responsibilities.
How do I apply for the RN Utilization Rvw Spclst - Utilization Management position at ketteringhealth?
Click the "Apply Now" button on this page. You will be redirected to ketteringhealth's official application portal hosted on icims where you can submit your application directly.
When was the RN Utilization Rvw Spclst - Utilization Management job at ketteringhealth posted?
This RN Utilization Rvw Spclst - Utilization Management position at ketteringhealth was posted on Jul 13, 2026. Apply as soon as possible — early applications are often reviewed first.
RN Utilization Rvw Spclst - Utilization Management
ketteringhealth
You'll be redirected to ketteringhealth's official application page on icims.