Ohio Licensed Patient Care Manager

A company is looking for a Patient Care Resource Manager - Retrospective Review.

Key Responsibilities

Conduct retrospective reviews of medical services to assess medical necessity and compliance with guidelines

Support the Utilization Management team with prior authorizations and concurrent reviews

Analyze claims data to identify trends and develop action plans for process improvements

Required Qualifications

Bachelor's degree in nursing and a current Ohio Registered Nurse license

Minimum of three years' experience in a clinical setting, with a focus on utilization or case management

Knowledge of managed health care concepts and experience with national guidelines (e.g., MCG)

Proficiency in Microsoft Office applications and electronic health records

Strong understanding of HIPAA regulations and compliance requirements