Lead Utilization Review Case Manager

Cleveland Clinic Abu Dhabi LLC; Abu Dhabi; On-site; AED 180,000 - 280,000; Full time

Job summary

Cleveland Clinic Abu Dhabi LLC is seeking an experienced Utilization Review Case Manager (RN) to lead admission and concurrent reviews using evidence-based criteria, ensuring medical necessity and appropriate level of care across departments.

You will educate inpatient and ED teams, implement process improvements, and interface with physicians and payors, while maintaining high standards of patient safety and service quality in a fast-paced hospital environment.

Qualifications

• Minimum 5 years of nursing experience.
• Strong knowledge of utilization management and medical necessity.
• Ability to perform concurrent and retrospective reviews.
• Effective communication and staff education.

Responsibilities

• Conduct admission and concurrent reviews according to evidence-based criteria.
• Perform initial reviews for admitted patients via ED, clinics, transfers.
• Notify unit CM if patient does not meet admission criteria.
• Document avoidable days.
• Provide clinical consultation on UM to physicians.
• Educate inpatient case managers and ED staff on UM.
• Participate in CM orientation and develop UM education.

Skills

Utilization Review

Evidence-based decision making

Communication

Conflict resolution

Critical thinking

Education

Registered Nurse (RN) license

Job description

Cleveland Clinic Abu Dhabi LLC is seeking an experienced Utilization Review Case Manager (RN) to lead admission and concurrent reviews using evidence-based criteria, ensuring medical necessity and appropriate level of care across departments.

You will educate inpatient and ED teams, implement process improvements, and interface with physicians and payors, while maintaining high standards of patient safety and service quality in a fast-paced hospital environment.