Utilization Review Nurse - Employee Health Plan (ehp)
Cleveland Clinic
Ohio, US
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.