Full Time Days
7am-4:30pm
40 Hours/Week
Utilization management and pediatric nursing experience preferred
The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices.
Responsibilities:
1. Conduct Utilization Review & Determine Appropriate Level of Care
Applies evidence‑based medical necessity criteria, validates admission status, and ensures all inpatient, observation, and outpatient-in-a-bed cases meet criteria. Collaborates proactively with physician advisors and attending providers for accurate level‑of‑care decisions and authorization of hospital days.
2. Manage Denials, Compliance, and Quality Improvement Activities
Participates in denial management and peer review processes, identifies compliance or ethical issues, and contributes to quality and safety initiatives aimed at improving departmental and hospital workflows.
3. Support Care Progression Through Interdisciplinary Collaboration
Actively engages in daily huddles, multidisciplinary rounds, and patient care discussions to understand service intensity, discharge barriers, and progression of care, while serving as a resource to the care team on utilization, documentation, and admission requirements.
4. Maintain Accurate and Timely Documentation
Clearly documents all reviews, interactions, and decisions in Midas, Epic, and other required systems.
5. Performs additional duties as assigned.
Other information:
Technical Expertise
1. Experience in inpatient clinical is required.
2. Experience in pediatrics is preferred.
3. Experience working with all levels within an organization is required.
4. Experience in healthcare is required.
5. Proficiency in MS Office [Outlook, Excel, Word] or similar software is required.
Education and Experience
1.Education: Bachelor's in nursing [BSN] is required. For employees hired after July 1, 2013, BSN is required or must be obtained within 5 years from date of hire.
2. Certification: Registered Nurse licensure is required.
3. Years of relevant experience: 3 years is required.
4. Years of experience supervising: None.
Full Time
FTE: 1.000000
Status: Remote
More Than a Job. It’s loving what you do - and why you do it.
Akron Children’s Hospital is ranked among the best pediatric hospitals by U.S. News & World Report, but it’s our compassionate approach to treatment that sets us apart. It’s creating special high-fives. Thinking of new ways to spark a smile. Holding hands to offer comfort. And working to get a giggle that brightens a room.
The minute you walk into Akron Children’s, you can sense that people here love what they do. From visits with the Doggie Brigade, to the balloons and smiles in the halls, the sights and sounds are all about one thing: the children.
We are the largest pediatric healthcare system in Northern Ohio and one of the fastest growing in the country. Akron Children’s has two hospital campuses in Northeast Ohio: one in Akron and the other in Boardman in the Mahoning Valley. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we’re making it easier for today’s busy families - regardless of where they live - to find the high-quality care they need.
No matter which of our locations you choose, you’ll see that when you give the most, you get more—support, rewards and satisfaction.
CAREER OPPORTUNITIES
It’s making the most of your days.
Our passion is felt every day in the way people care at every level. Whether you are working with children face-to-face, or behind the scenes supporting the care and services we deliver, you impact futures.
Visit us and see why it’s more than just a place to work. It’s a family.
Apply today at careers.akronchildrens.org.
