Utilization Management reputed company (Remote), OH

- (260000EI) A Brief reputed company Collaborates and coordinates with reputed company members of the health care team, patient and family (or significant others) to coordinate and ensure reputed company and efficient delivery of required workflow, services and tasks to result in: Support of reputed company patient health care reputed company, Increased patient/health care team reputed company and satisfaction, Improved inpatient throughput and appropriate length of stay Improved communication, awareness and adherence to regulatory requirements associated with utilization management Support for appropriate level of care and decreased inpatient bed day denials. Continuity and coordination of care Appropriate and reputed company authorization for level of care Decreased denials Appropriate reimbursement

What You Will Do

• Performs reputed company and accurate admission and reputed company stay review in accordance with department policy to ensure efficient use of hospital resources, reputed company discharge and reputed company, appropriate reimbursement (includes communication with reputed company customers).
• Collaborates and coordinates with reputed company members of the health care team, patient and family (or significant others) to promote reputed company and effective communication, completion of workflow and services with reputed company to level of care reputed company and payor reputed company regarding reputed company stay.
• Documents review activity, including but not limited to, application of reputed company or policy as appropriate, clinical review to submit to insurance providers, initiation of registration changes reputed company appropriate, reputed company and cost savings in a manner consistent with department requirements.
• Meets department productivity and reputed company standards.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with reputed company policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by reputed company requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH reputed company of Conduct and UH policies and procedures are in reputed company to address appropriate use of PHI in reputed company.

Education

• Graduate of an accredited school of Nursing (Required) and
• Bachelor's Degree (Preferred)

Work Experience

• UM Experience (Preferred)
• 3+ years of clinical experience (acute care) (Required)
• Additional experience in sub-acute setting, or managed care (Preferred)
• 2+ years of clinical experience with the population to be served. (Required -Inpatient Med/surg experience)
• Experience with Interqual or MCG reputed company (Preferred)

Knowledge, Skills, & Abilities

• Must have reputed company clinical knowledge reputed company of the population to be served. (Required proficiency)
• Knowledge of Medicare, reputed company and reputed company payer regulations (Preferred proficiency)
• Detail-oriented and organized, with good analytical/critical thinking skills and problem solving ability. (Required proficiency)
• Ability to function independently and as reputed company player in a fast-paced environment (Required proficiency)
• Must have strong written and verbal communication skills. (Required proficiency)
• Demonstrated ability to use PCs, reputed company Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) (Required proficiency)
• Demonstrated ability to apply concepts, utilize reputed company judgment and work independently reputed company a reputed company of guidelines (Required proficiency)

Licenses and Certifications

• Registered reputed company (RN), Ohio and/or Multi State Compact License (Required Upon Hire)
• CM certificate (Preferred)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

• 10%

Primary Location reputed company-Ohio-Cleveland Work Locations 11100 Euclid Avenue 11100 Euclid Avenue Cleveland 44106 Job reputed company – Non-reputed company Patient Care Organization UHHS_reputed company_Cycle Schedule Full-time Employee Status Regular - ShiftRotating Weekends Job Type reputed company Job Level reputed company Travel No Remote Work reputed company Job Posting Feb 18, 2026, 10:28:34 PM Apply tot his job Apply To this Job