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Utilization Management RN – Clinical Review & Cost Control
Job in
Columbus, Franklin County, Ohio, 43224, USA
Listed on 2026-09-08
Listing for:
Youritrecruiter
Full Time
position Listed on 2026-09-08
Job specializations:
-
Nursing
Clinical Nurse Specialist
Job Description & How to Apply Below
Youritrecruiter UM Nurse role involves conducting clinical reviews to assess medical necessity and efficiency of services requested by providers and members. It supports the health plan’s utilization management aligned with clinical guidelines and accreditation standards.
The position uses criteria such as MCG and Inter Qual for inpatient, outpatient, and ancillary reviews, aiming to deliver cost-effective, high-quality care and regulatory compliance.
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