Case Management/UR, RN

Case Management/UR, RN 4.0 4.0 out of 5 stars 615 Fulton Street, Port Clinton, OH 43452 Full-time Magruder Hospital 37 reviews Full-time About the Role We're hiring a Utilization Review Nurse to support accurate patient classification, care coordination, and compliance across our Transitional Care and acute care programs. In this role, you will ensure appropriate levels of care, manage payor communication, and help prevent denials through timely, thorough utilization review. Your work directly supports high-quality patient outcomes and strengthens our overall care delivery. What You'll Do Utilization Review & Care Classification

• Review physician documentation to determine appropriate patient status using MCG criteria
• Complete utilization review and payor notifications within required timelines
• Monitor patient progress and collaborate with medical staff to support safe, efficient care transitions
• Manage concurrent denials and coordinate appeal determinations Patient & Family Communication
• Initiate communication with insurance providers to secure preauthorization and monitor length of stay
• Support patients and families by explaining care classifications and next steps
• Participate in Transitional Care Program compliance activities Cross-Functional Collaboration
• Join multidisciplinary huddles for acute and Transitional Care patients
• Coordinate with Quality Department team members to ensure seamless service transitions
• Collect and report utilization data for QI/UR and Transitional Care committees Systems & Administration
• Navigate electronic medical records to document reviews and maintain accurate records
• Ensure compliance with CMS, Joint Commission, and payor-specific guidelines
• Maintain confidentiality and uphold HIPAA standards Our Culture & Values Our team is guided by Integrity, Ownership, Compassion, and Respect, creating a supportive environment where collaboration, accountability, and patient-centered care thrive.

Work Environment This is a 100% onsite position at our Port Clinton, OH facility. Apply Today! Required Associate's Degree, RN Diploma from an accredited nursing program Strong knowledge of Medicare guidelines and utilization review processes Excellent communication, critical thinking, and collaboration skills Proficiency with Microsoft Office and electronic medical record systems Preferred Bachelor's Degree in Nursing or actively pursuing Five years of recent clinical experience Case Management certification (CCMC or ACM) Magruder Hospital is an Equal Opportunity Employer and provides equal employment and advancement opportunities to all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, veteran status, disability, or any other protected class under the law. Magruder Hospital is a Drug Free Workplace. Any offer of employment will be contingent upon satisfactory completion of pre-employment drug screening, including screening for the presence of nicotine, satisfactory completion of background verification, and the results of a post-offer medical and physical examination.