Utilization Review Nurse/Case Management
Company: JTDMH
Location: Saint Marys
Posted on: February 15, 2026
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Job Description:
Job Description Job Description Hours of Job Part Time - 40
hours/5 days per pay period 7:30 AM-4:00 PM Every third weekend
rotation off-site; less than 3 hours per scheduled weekend Duties
and Key Responsibilities The Utilization Review Coordinator reviews
and clarifies patient status, applies initial and continued stay
criteria to determine medical necessity, prepares clinical reviews
to support payer authorization of hospital stays, and follows
inpatient and observation cases through resolution with clear,
trackable documentation in WellSky CarePort. Follows secondary
review process as necessary. Provides continued stay reviews for
behavioral health and attends the twice weekly team meetings.
Identifies and documents avoidable variances and denial activity.
Arranges P2P appeals. Audits and maintains compliance for IMM and
MOON delivery. Cross trains to other positions in Case Management
for coverage needs Must be receptive to changes as the position
demands Practices the Caring Model. Requirements
Clinical/Psychosocial skills in acute care setting. Strong team
player with internal and external customers. Must be adept and
organized and work effectively and efficiently with staff and
physicians Patient advocacy, compliance, and confidentiality are a
must. Education/Certifications Bachelor’s Degree from an accredited
school is required. Current Ohio Licensed Nurse. Experience
Background in Nursing required with 5 years or more of recent acute
care clinical experience. Grand Lake Health System provides equal
employment opportunities to all employees and applicants for
employment without regard to race, color, religion, gender, sexual
orientation, gender identity or expression, national origin, age,
disability, genetic information, marital status, amnesty, or status
as a covered veteran in accordance with applicable federal, state
and local laws. GLHS complies with applicable state and local laws
governing nondiscrimination in employment in all of our locations.
In addition, Grand Lake Health System is an At-Will Employment
employer.
Keywords: JTDMH, South Bend , Utilization Review Nurse/Case Management, Healthcare , Saint Marys, Indiana
