Concurrent Denial Nurse BU

Related keywords: remote job registered nurseremote job nurseremote job nursing

Job Overview

Cleveland Clinic Health System is seeking a Concurrent Denial Nurse for their remote position. The organization is focused on shaping a better future for healthcare. This role is essential for ensuring that patient care meets medical necessity standards, indicating the organization's commitment to high-quality healthcare services.

Job Details

The position of Concurrent Denial Nurse is located in Cleveland. The work shift is during the day, specifically from 7:30 AM to 4:00 PM, with occasional Saturday rotations. As a part of the team, you will work within the Care Management Nursing Institute, providing crucial support to the Utilization Management Department.

Key Responsibilities

As a Concurrent Denial Nurse, your primary responsibilities will include:

• Supporting the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient denials to ensure they meet medical necessity criteria.
• Serving as a subject matter expert in Utilization Management, assisting in educating caregivers and physicians regarding processes and best practices.
• Collaborating with local physician advisors and participating actively in peer-to-peer processes.
• Analyzing clinical denials, following payer-specific processes, and communicating effectively to identify and resolve issues related to denials.
• Utilizing knowledge of medical terminology, anatomy and physiology, and disease processes to contribute to case reviews and improve workflows.

Required Skills and Qualifications

The ideal candidate for this position must possess:

• Completion of an accredited Registered Nursing Program (RN)
• A Bachelor’s Degree in Nursing or a related field
• A current valid license in the State of Florida as a Registered Nurse (RN)
• Basic Life Support (BLS) certification through the American Heart Association (AHA) or the American Red Cross
• A minimum of three years of full-time experience in Utilization Management
• Demonstrated above-average competence in Utilization Management processes

Preferred Qualifications

While not required, the following qualifications are preferred:

• Case Management certification (CCM or ACM)
• Experience in educational roles within healthcare settings

Work Environment and Physical Requirements

The role will involve

• Extensive reading, computer usage, and telephone communication.
• The ability to maintain a professional demeanor under pressure or adverse conditions.

You must also adhere to Cleveland Clinic’s standards for personal protective equipment and provide an influenza vaccination annually or seek an exemption.

Compensation and Recognition

Specific salary details were not provided in the text. However, Cleveland Clinic is a reputable organization, known for its dedication to its employees and for providing endless support and appreciation.

Culture and Values

Cleveland Clinic emphasizes equality in the workplace and adheres to policies protecting candidates based on color, race, religion, national origin, age, sex, sexual orientation, marital status, and other characteristics protected by law. The organization insists on a drug-free environment, with employment being contingent on standard substance abuse testing. They also have a policy to encourage diverse hiring, including women, minorities, veterans, and individuals with disabilities.

Conclusion

This position at Cleveland Clinic represents a unique opportunity to impact patient care and contribute to a transformative healthcare system. If you are a Registered Nurse specializing in utilization management who desires to work in a collaborative and supportive environment, consider applying for the Concurrent Denial Nurse role.

This job offer was originally published on himalayas.app