Utilization Management RN Reviewer
ccf · Remote Location
Job description
About the role
Join Cleveland Clinic Health System as a Utilization Management RN Reviewer, working remotely to evaluate patient stays and ensure appropriate use of resources. This position supports quality and reimbursement goals across the organization.
Key responsibilities
- Perform admission, concurrent, retrospective and clinical systems reviews to assess medical necessity and appropriateness of stays.
- Review medical records, provide clinical information to payers, collect and report UM data, and manage concurrent denial appeals.
- Interact with clinical teams, physician advisers and participate in special projects and quality improvement initiatives.
Required profile
- Graduate of an accredited nursing program with current RN licensure.
- Minimum three years of full‑time clinical nursing experience and BLS certification.
- Strong analytical ability to apply medical necessity guidelines and identify problems.
Required skills
- Proficiency with Microsoft Office.
- Experience using hospital information systems and related software.
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Published 4 days ago
Expires 1 month from now
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Remote Location
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