Scope of Position / Position Summary: The Internal Resource Pool (IRP) - Utilization Management Case Manager (UM CM) implements and supports the philosophy, mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center. The UM CM contributes to the hospitals Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payer rules, regulations, and MCG guidelines. The IRP - UM CM maintains an awareness of State and National health