Concurrent Denial Nurse BU job opportunity at Cleveland Clinic.

Home Jobs In United States Of America Tag: Job Concurrent Denial Nurse BU position at Cleveland Clinic


DatePosted 25 Days Ago bot
Cleveland Clinic Concurrent Denial Nurse BU
Experience: General
Pattern: full-time
Country:
apply Apply Now
Salary:
Status:

Job

Copy Link Report
degreeOND
loacation Indian River Hospital, United States Of America
loacation Indian River H..........United States Of America

                     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 Concurrent Denial Nurse BU                          Location Cleveland                      Facility Remote Location                       Department Care Management Nursing Institute-Nursing Institute                        Job Code 0019IR                       Shift Days                         Schedule 7:30am-4:00pm                         Job Summary                           Job Details CCIR CBA Bidding Date 01/07/2026 - 01/14/2026 Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world .       As a Concurrent Denial Nurse ,   you will support the Utilization Management Department   by   reviewing concurrent and retrospective clinical inpatient denials to ensure medical necessity criteria   is   met.   We are looking for a   Registered   Nurse who is a subject matter expert in   utilization   management ,   has experience with MCG criteria ,   and   is   comfortable educating Caregivers and Physicians.   In this role, you will get to work with a dynamic team of like-minded professionals   and gain experience at an elite healthcare organization.   A caregiver in this position work s   days from   7:30AM – 4: 0 0PM , including rotating Saturdays.   A caregiver who excels in this role will:    Serve as the expert in Utilization Management functions and   be   a resource to the department in general and the hospital .   Review and analyze concurrent and retrospective clinical denials and follow the specific payer processes .   Serve as an expert in payer specific process and communicate between payer and CCIRH to identify/resolve denial process issues .   Work in collaboration with the local physician advisor team and support the   peer-to-peer   process .   Perform the routine activities of a UM Specialist when needed while taking a leadership role .   Utilize knowledge of medical terminology, anatomy and physiology, diagnosis, surgical   procedures   and basic disease processes .   Utilize knowledge and experience with Care Guidelines and /or other UM criteria sets .   Utilize advanced interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with members of the health care team .   Recommend resource   utilization   when needed .   Utilize analytical skills to gather data,   identify   problems   and   facilitate   resolution .   Prioritize and organize work to meet changing priorities .   Utilize knowledge of multiple hospital information systems and   department’s   software .   Assist   with education and monitoring of UM   specialist's   reviews .   Participate in payer specific p2p calls or local meetings as needed .     Minimum qualifications for the ideal future caregiver include:    Completion of an accredited Registered Nursing Program (RN)   Bachelor’s   D egree in Nursing   or related field   Current valid license in the State of Florida as a Registered Nurse (RN Single State) Current Florida Resident   Basic Life Support (BLS) certification   through the American Heart Association (AHA) or American Red Cross   Three years of full-time Utilization Management experience   Demonstrated above average competence in Utilization Management Processes     Preferred qualifications for the ideal future caregiver include:    Case Management certification (CCM or ACM)   Physical Requirements: Requires extensive reading, telephone , computer use Must be able to work well under pressure and maintain professional demeanor under adverse conditions 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 drug free environment. All offers of employment are followed by testing for controlled substances. 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

Other Ai Matches

New Grad RN Resident - Transplant Specialty Care Applicants are expected to have a solid experience in handling Job related tasks
Social Worker LCSW Applicants are expected to have a solid experience in handling Job related tasks
Advanced Practice Provider (NP/PA/CNS) - Hospital Medicine, Euclid Hospital II Nights Applicants are expected to have a solid experience in handling Euclid Hospital II Nights related tasks
Phlebotomist Applicants are expected to have a solid experience in handling Job related tasks
Weekender Registered Radiology Technologist Applicants are expected to have a solid experience in handling Job related tasks
Medical Assistant - Urology Clinic Applicants are expected to have a solid experience in handling Job related tasks
Registered Respiratory Therapist - Enterprise Flexible Staffing Pool Applicants are expected to have a solid experience in handling Job related tasks
RN Clinical Adjunct Faculty - Internal Medicine and Telemetry Applicants are expected to have a solid experience in handling Job related tasks
Surgical Technologist Applicants are expected to have a solid experience in handling Job related tasks
Child Life Specialist NE - Inpatient Applicants are expected to have a solid experience in handling Job related tasks
New Grad RN Resident - Float Pool Applicants are expected to have a solid experience in handling Job related tasks
PRN LPN Clinic - Gastroenterology Applicants are expected to have a solid experience in handling Job related tasks
Pharmacy Clinical Specialist - Cardiology Applicants are expected to have a solid experience in handling Job related tasks
CT Technologist Applicants are expected to have a solid experience in handling Job related tasks
Paramedic - Emergency Department Applicants are expected to have a solid experience in handling Job related tasks
RN Ambulatory Team Lead - Women's Health Applicants are expected to have a solid experience in handling Job related tasks
Physical Therapist - Neuro Institute Applicants are expected to have a solid experience in handling Job related tasks
RN - Medical ICU (MICU) Applicants are expected to have a solid experience in handling Job related tasks
Surgical Assistant Applicants are expected to have a solid experience in handling Job related tasks
LPN Clinic - Family Medicine Applicants are expected to have a solid experience in handling Job related tasks
RN - Gastroenterology & Hepatology Applicants are expected to have a solid experience in handling Job related tasks
Mammography Technologist Applicants are expected to have a solid experience in handling Job related tasks
Phlebotomy Technician Applicants are expected to have a solid experience in handling Job related tasks