Utilization Management Resource Center Specialist

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

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Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world.    

As Utilization Management Resource Center Specialist, you will support the Utilization Management Specialistic and Care Management staff in maximizing financial reimbursements. Using your collection, banking and healthcare knowledge, you will help manage payor communication and documentation for authorization processes. 

A caregiver in this position works days from 8:30AM — 5:00PM.  

A caregiver who excels in this role will:  

• Conduct payor-specific communications and support for the Utilization Management and Care Management team, including direct communication of clinical reviews, monitoring of payor issues, and facilitating necessary retrospective reviews. 
• Track and enter authorizations and other benefit information into appropriate electronic systems, such as Allscripts, ADT and EAPM. 
• Participate in central call center, servicing all hospitals and payors, verifying information and resolving common problems. 
• Provide necessary verbal and electronic communication to and from Case Management staff, serving as a liaison between hospital personnel and the various payors. 
• Complete data tracking and collection to assist with the identification of routine statistics and problems and trends, such as turn-around time, accuracy of reviews, etc. 
• Participate in early identification of issues that would result in delayed or non-payment of claims and takes a proactive approach to problem resolution. 
• Act as a resource and superuser for Case Management staff on payor related issues and Allscripts. 

Minimum qualifications for the ideal future caregiver include:  

• High School Diploma 
• Post-High School coursework (Vocational, Associates or Bachelor program) in Business, Finance, Accounting OR equivalent work experience in a financial environment 
• Four years of previous experience in collection or other related bank, finance or healthcare experience OR Associate's Degree in Accounting, Finance or related field and three years of experience OR Bachelor's Degree in Accounting, Finance or related field and two years of experience 

Preferred qualifications for the ideal future caregiver include:  

• Bachelor's Degree in health-related field 
• Experience processing medical insurance claims 

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/      

Physical Requirements:

• Ability to perform work in a stationary position for extended periods
• Ability to operate a computer and other office equipment
• Ability to communicate and exchange accurate information
   

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

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