See more Collapse

Utilization Review Nurse- Utilization Management

1 month ago

Cleveland, United States Metro Health Full time

Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 72.00 Shift: 7a-730p The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers. Summary: Responsible for supporting the physician and interdisciplinary team in the provision of patient care by ensuring the appropriate level of care at the point of entry. The utilization review nurse will work on defined patient populations and is responsible for an initial clinical review at the point of patient entry to the inpatient care setting, this includes observation status. Will collaborate with other interdisciplinary team members to develop and participate in a systematic approach to denial management, and in so doing reduce organizational exposure to revenue loss. Actively participates in the denial management process; improve reimbursement by optimizing revenue recovery due to inappropriate level of care, failure to meet medical necessity, and/or severity of illness. Upholds the mission, vision, values, and customer service standards of The MetroHealth System. Qualifications: Required: Bachelor’s degree in Nursing (applies to placements after 1/1/2017). Current Registered Nurse License State of Ohio. Minimum of five years clinical experience. Able to work independently and as a member of an interdisciplinary team. Knowledge and experience with medical necessity criteria for inpatient admission and observation placement. Knowledge and experience of denials based on the absence of documented medical necessity or failure to meet severity of illness and intensity of service criteria. Knowledge of internal criteria set and Milliman Health Management Guidelines. Excellent interpersonal communication and negotiation skills. Strong analytical, data management, and PC skills. Current working knowledge of, utilization management, case-management, performance improvement, and managed care reimbursement. Strong organizational and time management skills. Preferred: Two years of experience with case management, utilization review. Physical Demands: May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating. May need to remain still for extended periods, including sitting and standing. Ability to communicate in face-to-face, phone, email, and other communications. Ability to read job related documents. Ability to use computer.

We have other current jobs related to this field that you can find below

  • Utilization Review Nurse-Utilization Management

    4 weeks ago

    Cleveland, United States The MetroHealth System Full time

    Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 72.00 Shift: 8a-430p The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other...

  • Utilization Review Specialist

    1 month ago

    Cleveland, Ohio, United States MetroHealth Full time

    Utilization Review Specialist - Utilization ManagementLocation: METROHEALTH MEDICAL CENTERBiweekly Hours: 80.00Shift: 8a to 430pThe MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh...

  • RN Utilization Management Specialist

    3 weeks ago

    Cleveland, United States Cleveland Clinic Full time

    Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. 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.As an RN...

  • RN Utilization Management Specialist

    3 months ago

    Cleveland, United States Cleveland Clinic Full time

    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...

  • Director, Portfolio Management

    1 month ago

    Cleveland, United States Huntington Bancshares Inc. Full time

    Description Summary: Huntington's Director, Portfolio Management will co-manage a book of business greater than $2.5 billion in commitments in the Bank's Power & Utilities vertical within Huntington's Corporate Specialty and Government Banking group. The Director, Portfolio Management services and, in conjunction with Relationship Management, deepens an...

  • Utility III

    3 weeks ago

    Cleveland, United States Nestl S.A Full time

    Foods people love. Brands people trust. And a career that nourishes your future like no other. If you're driven by the passion to do something meaningful that changes lives, Nestl is the place for you. Nestl USA is one of seven operating companies Utility

  • Utility

    3 months ago

    Cleveland, United States ASR GroupDomino Sugar Full time

    ASR Group is the worlds largest refiner and marketer of cane sugar, with an annual production capacity of more than 6 million tons of sugar. The company produces a full line of grocery, industrial, food service and specialty sweetener products. Across North America, ASR Group owns and operates six sugar refineries, located in Louisiana, New York, California,...

  • Experienced Utility Locator

    2 months ago

    Cleveland, United States One Call Concepts Locating Services Inc. Full time

    Job DescriptionJob DescriptionMinimum Requirements: A strong work ethic, ability to come to work everyday, ability to take direction and training.Paid training will be provided.Seeking quality minded, driven individuals with:Clean driving recordClean background checkMust pass a pre-employment drug screeningAble to work outside in all weather.Familiarity with...

  • Experienced Utility Locator

    3 months ago

    Cleveland, United States One Call Concepts Locating Services Inc. Full time

    Job DescriptionJob DescriptionMinimum Requirements: A strong work ethic, ability to come to work everyday, ability to take direction and training.Paid training will be provided.Seeking quality minded, driven individuals with:Clean driving recordClean background checkMust pass a pre-employment drug screeningAble to work outside in all weather.Familiarity with...

  • Utility Operator

    4 months ago

    Cleveland, United States Bula Forge & Machine Full time

    Job DescriptionJob DescriptionThe Utility handles the setup, operation, presses and forging machines to perform hot or cold forging by flattening, straightening, bending, cutting, piercing, or other operations to taper, shape, or form metal. Operating and set-up of CNC equipment.Secondary operations: assembly, shipping/receiving, die maintenance, grinding,...

  • Forge Utility

    1 month ago

    Cleveland, United States Mid-West Forge Corporation Full time

    Job DescriptionJob DescriptionOverview: Utility is the entry level position in the Forge. Assists workers by performing general labor operations in the positions of Helper, Rack Person, Hook-Up, and Loader and supports operators as needed.Essential Duties and Responsibilities:Facilitates set up activities as requested by operator.Assist Operators pulling...

  • Machining Utility

    3 months ago

    Cleveland, United States Mid-West Forge Corporation Full time

    Job DescriptionJob DescriptionPosition Summary: Utility is the entry level position in Machining Department. Assists workers by performing general labor operations in the positions of Helper, Rack Person, Hook-Up, and Loader and supports operators as needed.Essential Duties and Responsibilities: include the following. Other duties may be assigned.Facilitates...

  • Food Service Utility

    7 days ago

    Cleveland, United States Judson Full time

    Job DescriptionJob DescriptionESSENTIAL JOB DUTIES:Perform a variety of tasks including general sanitation procedures proper food serving & storage, operating kitchen equipment and dish machine, handling chemicals and cleaning equipment, assemble and delivers room service orders, demonstrates excellent customer service skills, adheres to all HACCP procedures...

  • Dishwasher / Utility / Bake Assist

    3 months ago

    Cleveland, United States Nothing Bundt Cakes #269 Full time

    Job DescriptionJob DescriptionDishwasher/Utility/Bake Assist Employee : No experience necessary. We will train the right person to be an awesome member of our team!We offer a fast-paced and fun Team Culture, Competitive Pay, Performance Bonuses, Employee Discounts, and More!Position Summary:Dishwasher/Utility/Bake Assist Employee Description:The...

  • Utility Maintenance Person

    4 weeks ago

    Cleveland, United States Northeast Ohio Regional Sewer District Full time

    JOB SUMMARY This is a training position pursuant to achieving the qualifications as specified in the Collective Bargaining Agreement (CBA) and Maintenance Training Program guidelines to prepare the candidate to bid on the Plant Utility Maintenance Person (PUMP) position. Under general supervision, performs skilled work in maintaining and repairing Sewer...

  • Dishwasher / Utility / Bake Assist

    3 months ago

    Cleveland, United States Nothing Bundt Cakes #269 Full time

    Job DescriptionJob DescriptionBenefits:Bonus based on performanceCompetitive salaryDental insuranceEmployee discountsFlexible scheduleHealth insuranceOpportunity for advancementPaid time offParental leaveTraining & developmentVision insuranceDishwasher/Utility/Bake Assist Employee : No experience necessary. We will train the right person to be an awesome...

  • Utility Systems Repairer-Operator

    2 weeks ago

    Cleveland, United States Veterans Health Administration Full time

    The duties include but are not limited to: Operating and safely maintaining three 25,000 and one 17,000 pound per hour water tube high pressure steam boilers. Safely and efficiently maintaining five 1,200 ton centrifugal chillers, associated cooling towers and all related pumps and systems. Operating and safely maintaining two 200 ton process chillers,...

  • Utility Systems Repairer-Operator

    2 weeks ago

    Cleveland, Ohio, United States Veterans Health Administration Full time

    The duties include but are not limited to:Operating and safely maintaining three 25,000 and one 17,000 pound per hour water tube high pressure steam boilers. Safely and efficiently maintaining five 1,200 ton centrifugal chillers, associated cooling towers and all related pumps and systems. Operating and safely maintaining two 200 ton process chillers,...

  • Mill Utility- Cleveland, TN

    4 days ago

    Cleveland, United States ADM Full time

    Job Description Mill Utility- Cleveland, TN This is an hourly position.Position Summary:Under limited supervision, performs various duties in the wheat mill. The duties may vary by day and hours may vary based on assignment. Duties may include doing cleaning, operating motorized equipment such as scissor lift and fork trucks, roll changes and minor...

  • Food Service Utility

    3 months ago

    Cleveland, United States Judson Full time

    Job DescriptionJob DescriptionFood Service UtilityGeneral Purpose:Greets guests in Dining Rooms and takes food and beverage orders and delivers items to guests efficiently and professionally. Serves nourishing and attractive meals and other foods as required to support the menu, specific to diet orders and other catered events. Follows and comprehends...