OCM Manager
Unisys
Cloud
Patient Care Resource Manager – Retrospective Review
The Ohio State University, Main Campus
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Conducting retrospective reviews of medical services to determine medical necessity
- Collaborating with providers, internal departments, and external partners
- Supporting the Utilization Management team with prior authorization and concurrent reviews
- Analyzing claims data to identify trends and anomalies
- Developing and implementing action plans to address identified issues
Requirements
- Bachelor’s degree in nursing
- Current Ohio Registered Nurse license
- Minimum three years’ experience in a clinical setting required
- Experience in utilization and/or case management
- Knowledge of managed health care concepts
- Ability to evaluate medical records and other health care data
- Strong organization and time management skills
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible working arrangements
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical necessity evaluationclaims data analysisutilization managementprior authorizationconcurrent reviewsaction plan developmentcase management
Soft skills
collaborationorganizationtime management
Certifications
Bachelor’s degree in nursingOhio Registered Nurse license
