At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job Title

Care Transplant Case Manager - Managed Care

                        

Location

Cleveland

                    

Facility

Remote Location

                     

Department

Managed Care-Finance

                      

Job Code

T24041

                     

Shift

Days

                       

Schedule

8:00am-5:00pm

                       

Job Summary

                         

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

In this role, caregivers will play the important role of providing clinical information to insurance companies and ensuring authorization is obtained for future/elective surgeries. This position also coordinates peer-to-peer reviews with insurance Medical Directors and Cleveland Clinic physicians as well as coordinates all pre-determination cases. By taking this opportunity, you will join a fun, supportive, motivated, and detail-oriented team that is looking for a nurse with these qualities to join the team. Even while working remotely, this team does their best to stay connected and encourage each other. This team offers team projects, various virtual development resources, and continued professional growth in a steadily growing team

Caregivers in this role will work from a flexible 8:00am to 5:00pm. This is a remote position with the option to train on-site at our Westcreek (Independence) facility.

A caregiver who excels in this role will: 

• Provide insurance companies with detailed clinical information when required to complete the authorization and pre-certification process. 
• Communicate and attempt to resolve level of service discrepancies between CCF and insurance companies. 
• Coordinate level of service justification directly with physician and communicate directly with third party payers to obtain approval. 
• Complete responses on behalf of physician for denials. 
• Review medical records and communicate with physicians to obtain authorization while also reviewing transplant case loads which include solid organ transplants and potential cellular therapies.
• Ensure that clinical and financial information is accurate and communicated to transplant networks.
• Contact dictate rates that need to be paid.
• Coordinate peer to peer reviews with CCF physicians and the insurance company Medical Director. Reviews are completed for CCF physicians at Main Campus and the community hospitals. 
• Coordinate pre-determinations for specific procedures and maintain confidentiality of all patients' related information. 
• Adhere to all JCAHO and Medicare compliance regulations. 

Minimum qualifications for the ideal future caregiver include: 

• Graduate of an accredited practical/vocational or professional nursing program
• Current state licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN)
• 2 or more years of experience in coding or a patient care acute facility.

Preferred qualifications for the ideal future caregiver include: 

• Experience in working at a tertiary care medical facility
• Excellent verbal and written communication skills
• Excellent customer service and organizational skills

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/

Physical Requirements:

• Requires extensive sitting and dexterity to perform work on a PC.
• Requires walking for extended periods of time.
• Good visual acuity through normal or corrected vision.
• Sedentary Work - Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required. 

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities