Ohio Licensed Utilization Management Nurse

To support effective healthcare delivery, the full-time remote Ohio Licensed Utilization Management Nurse will conduct medical necessity reviews, manage denials and compliance, and collaborate with interdisciplinary teams to ensure appropriate utilization of hospital resources. Key responsibilities Conduct Utilization Review & Determine Appropriate Level of Care by applying evidence-based medical necessity criteria Manage Denials, Compliance, and Quality Improvement Activities to enhance departmental workflows Support Care Progression Through Interdisciplinary Collaboration by engaging in daily huddles and patient care discussions Required qualifications Bachelor's in nursing (BSN) is required Registered Nurse licensure is required 3 years of relevant experience in inpatient clinical settings is required Experience in pediatrics is preferred Proficiency in MS Office (Outlook, Excel, Word) or similar software is required