Posted:
8/29/2024, 10:17:07 PM
Location(s):
Texas, United States ⋅ Florida, United States
Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior
Field(s):
Medical, Clinical & Veterinary
Utilization Management RN Reviewer - Care Management Nursing Institute
Join Cleveland Clinic’s Martin North Hospital where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are family. This downtown Stuart hospital provides top-quality patient care to the communities in and around Martin County on the beautiful Indian River. The caregivers at Martin North Hospital have made it an excellent medical facility and a home away from home.
Utilization Management (UM) Specialists perform UM activities, such as admission review, concurrent review, retrospective chart review and clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient’s hospital stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review, providing clinical information to payers, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and special projects.
A caregiver in this position works 8:00AM – 4:30PM. Remote Work
Required qualifications for the ideal candidate include:
Graduate of an accredited school of nursing with licensure as a Registered Nurse (RN) in the State.
Current valid license as a Registered Nurse (RN).
Basic Life Support (BLS) through American Heart Association (AHA).
3-5 years of full time current clinical experience as a Registered Nurse.
Ability to prioritize and organize work to meet changing priorities.
Ability to utilize analytical abilities required to gather data.
Ability to use clinical judgment to apply predetermined criteria or use independent clinical judgment when no predetermined criteria exist to identify problems, facilitate resolution, recommend corrective action, and report results effectively.
Ability to use independent clinical judgment in reviewing records to determine status of patients stay, if proper procedures have been followed, seriousness of incidents and ability to identify need for and participate in focused reviews, special projects and identify opportunities for improvement.
Makes recommendations regarding appropriateness of the treatment plan for continued stay and safety of the discharge plan.
Achieves a minimum of 85% on IRR quarterly.
Completes utilization management for assigned patients with at least 25-30 reviews per day.
Applies medically necessity guidelines accurately to monitor appropriateness of admission and continued stays.
Documents appropriately in UM notes to provide evidence that the UR process for the case was followed.
Preferred qualifications for the ideal candidate also include:
UR Experience
BSN
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/
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
Website: https://clevelandclinic.org/
Headquarter Location: Cleveland, Ohio, United States
Employee Count: 1001-5000
Year Founded: 1921
IPO Status: Private
Last Funding Type: Grant
Industries: Health Care ⋅ Hospital ⋅ Medical ⋅ Non Profit