Utilization Review Nurse - Employee Health Plan (ehp)

Cleveland Clinic Health System

northeast Ohio, US
Base: not specified; bonus/equity: not specified; ...
Fully remote
Clinical information to insurance companies
Coordinate peer-to-peer reviews
Manage pre-determination cases
As a Utilization Review Nurse, you will provide clinical information to insurance companies to obtain authorization for future and elective surgeries, coordinate peer to peer reviews between insurance Medical Directors and Cleveland Clinic physicians and manage all pre-determination cases

Job Summary

  • As a Utilization Review Nurse, you will provide clinical information to insurance companies to obtain authorization for future and elective surgeries, coordinate peer to peer reviews between insurance Medical Directors and Cleveland Clinic physicians and manage all pre-determination cases.
  • This position primarily supports utilization review, with a strong focus on outpatient prior authorization requests.
  • A caregiver in this role works remotely from 8:00 a.m. – 4:30 p.m.

Matching Summary

As a Utilization Review Nurse, you will provide clinical information to insurance companies to obtain authorization for future and elective surgeries, coordinate peer to peer reviews between insurance Medical Directors and Cleveland Clinic physicians and manage all pre-determination cases.

Salary

Base: Not specified; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • clinical information to insurance companies
  • coordinate peer-to-peer reviews
  • manage pre-determination cases
  • outpatient prior authorization requests
  • review medical records

Nice-to-have

  • fun, supportive, motivated team
  • detail-oriented nurse
  • transforming the patient experience

Key Requirements

  • Licensed Practical Nurse (LPN) or Registered Nurse (RN)
  • Two or more years of experience
  • residency in northeast Ohio

Work Rights

Not specified

Tailored Resume

Cover Letter