Remote RN Utilization Review Specialist

ccf; United States; À distance; USD 75 000 - 105 000; Plein temps

Résumé du poste

Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure appropriate resource use.

Ideal candidates are RNs with strong clinical judgment, knowledge of UM criteria, and proficiency with Microsoft Office.

Qualifications

• Graduate of an accredited school of nursing.
• Current state licensure as an RN.
• Basic Life Support (BLS) certification through AHA or Red Cross.
• Three years of full-time RN clinical experience.
• Knowledge of medical terminology, anatomy and physiology, diagnosis, procedures and basic disease processes.
• Analytical ability to gather data and decide conformity to criteria.
• Basic knowledge of medical records coding standards.
• Awareness of licensing and accreditation standards.
• Proficient with Microsoft Office.
• Knowledge of Care Guidelines and Medical Necessity Criteria and UM criteria sets.
• Ability to assess medical records and determine length of stay and discharge procedures.

Responsabilités

• Perform UM activities: admission review, concurrent and retrospective chart review.
• Review medical records and provide clinical information to payers.
• UM data collection and reporting responsibilities.
• Participate in focused reviews and opportunities for improvement.
• Document UR processes and maintain UM notes with evidence.

Connaissances

RN

Analytical thinking

Medical terminology

Medical records review

Care Guidelines

Medical Necessity Criteria

Microsoft Office

Billing knowledge

UM criteria

Hospital information systems

Formation

Bachelor of Science in Nursing (BSN)

Registered Nurse licensure

BLS certification

Case Management Certification (CCM)

Description du poste

Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure appropriate resource use.

Ideal candidates are RNs with strong clinical judgment, knowledge of UM criteria, and proficiency with Microsoft Office.