Concurrent Denial Nurse BU - Utilization Management

Cleveland Clinic(1 month ago)

RemoteFull TimeSenior$140,597 - $189,177 (estimated)Utilization Management

About this role

The Concurrent Denial Nurse supports Cleveland Clinic’s Utilization Management function by evaluating inpatient denial cases to confirm medical necessity and align with payer requirements. The role partners with internal clinical stakeholders and payer representatives to address denial-related issues and support appropriate care decisions within an inpatient setting.

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Required Skills

Utilization Management
Denial Review
Medical Necessity
MCG Criteria
Payer Processes
Clinical Documentation
Peer-To-Peer
Physician Education
Case Review
Medical Terminology

+4 more

Qualifications

Registered Nurse (RN) Program
Florida RN License
BLS (AHA or American Red Cross)
CCM
ACM
Bachelor’s Degree in Nursing

About Cleveland Clinic

clevelandclinic.org

Cleveland Clinic is a not‑for‑profit academic medical center founded in 1921 that provides comprehensive clinical and hospital care across a large integrated health system. It is known for world‑class specialty care, multidisciplinary teams, and leadership in medical research, education, and health information. The organization operates hospitals, outpatient centers and digital/telehealth services, and employs roughly 65,000 staff to serve patients regionally and internationally.

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