RN Utilization Management Specialist

Summa Health; Cleveland (OH); On-site; USD 78,000 - 117,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Life Insurance

Disability (short/long-term)

Retirement Savings Plan

Flexible Spending Accounts

Employee Assistance Program

Identity Theft Protection

Pet Insurance

Education Assistance

Daily Pay

Job summary

Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The role involves performing initial and concurrent reviews, aligning with Medicare/ payer guidelines, and applying clinical criteria to determine appropriate inpatient vs.

observation status. Responsibilities include collaborating with the Transitional Care Team and physician advisors, ensuring compliant discharge appeals, and supporting denial review

Qualifications

• ADN required; BSN preferred.
• Ohio RN license required.
• 2+ years acute care or managed care experience.

Responsibilities

• Perform initial and concurrent clinical reviews to authorize acute care services.
• Collaborate with Transitional Care Team, Physician Advisors, Providers and department leadership on patient status and criteria.
• Support appeals of payer denials with internal teams and external advisors.

Skills

Communication

Data analysis

Clinical expertise

Independent work

Population-specific care

Insurance knowledge

Education

RN-ADN

BSN preferred

Ohio RN license

CCNE/ACEN accredited program

Job description

Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The role involves performing initial and concurrent reviews, aligning with Medicare/ payer guidelines, and applying clinical criteria to determine appropriate inpatient vs.

observation status. Responsibilities include collaborating with the Transitional Care Team and physician advisors, ensuring compliant discharge appeals, and supporting denial review