**This is a local remote position. Only residents of Northeast Ohio will be considered for this position.

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Clinical Denial Education and Quality Coordinator, you will:

• Provide one-on-one clinical denial education to Finance Case Managers, Physician Advisors, Hospital departments and institutes.

• Remain accessible as a subject matter expert for CCHS regarding clinical denials, payer policies and clinical criteria.

• Conduct quality reviews of Finance Case Managers.

• Participate in process improvement activities based on audit results.

The ideal future caregiver is someone who:

• Has administrative and clinical nursing experience.

• Demonstrates a strong work ethic in a fast-paced, high demand environment.

• Has excellent communication, analytical and critical thinking skills.

• Is detail oriented.

Caregivers in this position find that they learn something new every day. While enjoying the flexibility of a remote work environment, you will help support the enterprise by not only preventing denials but fighting them as well.

At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

• Educates and mentors new employees through the on-boarding process.

• Monitors compliance of job standards through quality audits of Finance Case Managers

• Compiles monthly quality audit reports for management

• Provides feedback to the Clinical Denial Leadership Team regarding process improvement and efficiency opportunities within the team.

• Identifies and reports payer trends to Payer Contract Specialist.

• Recommends quality improvements and revenue enhancements.

• Participates in the development of clinical denial policies and review of existing policies.

• Educates groups and individuals within and external to Clinical Denial Team regarding denial trends, root cause and process improvement opportunities.

• Assists with Finance Case Manager Responsibilities as time permits.

• Promotes good morale and cooperation - encourages others, values their input, shares information and seeks ways to add value both to the customer and to the team.

• Seeks opportunities to learn new skills and actively coaches and encourages team members to do the same.

• Complies with CCHS and departmental policies and procedures consistently.

• Other duties as assigned.

Education:

• BSN or Bachelor's degree in a related field preferred.

Certifications:

• Licensed Registered Nurse (RN) in the state of Ohio required.

• Professional certification as a Case Manager preferred.

Complexity of Work:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

• Excellent verbal and written communications required and must be able to adjust educational delivery to audience.

• Must be able to work in a high-paced, high-demand environment.

• Must be detailed oriented and analytical in nature.

Work Experience:

• Minimum of 5 years of Clinical Denial or Utilization Management experience required.

• Expertise with InterQual and MCG disease management ideologies required.

• In-depth familiarity with third party billing requirement and regulations, billing documentation requirements required.

• Understanding of CPT and HCPCS coding guidelines preferred.

Physical Requirements:

• Manual dexterity to operate office equipment.

• Requires extended periods of standing, walking, sitting and carrying up to 25 pounds.

• Normal or corrected vision and hearing to normal range.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

Pay Range

Minimum hourly: $27.65

Maximum hourly: $42.17

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities