Clinical nurse manager [h1.location_city]
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Clinical nurse manager • cleveland oh
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Join our dynamic team as a Clinical Review Nurse, where you will play a crucial role in evaluating medical claims and supporting internal appeals.
This position is essential for ensuring compliance ...[show_more][last_updated.last_updated_variable_days]
At Strive Health, we're driven by a purpose : transforming the broken kidney care system.Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcom...[show_more][last_updated.last_updated_variable_days]
The nurse navigator supports a busy clinic working with the providers and managing the patients care with Pulmonary HTN.Occasional travel to cover shifts within the UH footprint.Provides virtual cl...[show_more][last_updated.last_updated_variable_days]
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being : affordable housing, a cleaner environment, economic...[show_more][last_updated.last_updated_30]
JOIN US IN MAKING THE MOST OF EVERY DAY!.Hospice of The Western Reserve operates in celebration of the individual worth of each life, we strive to relieve suffering, enhance comfort, promote qualit...[show_more][last_updated.last_updated_30]
As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations.
As the facility leader, you will be part of a close-k...[show_more][last_updated.last_updated_variable_hours]
BD is one of the largest global medical technology companies in the world.Advancing the world of health™ is our Purpose, and it’s no small feat.
It takes the imagination and passion of all of us—fro...[show_more][last_updated.last_updated_variable_days]
Now Offering a $2,000 Sign-on Bonus.The starting salary for this role is $60,000 per year.At Applewood, we prioritize our employees and their wellbeing.
We provide competitive benefit options to our...[show_more][last_updated.last_updated_30]
Southwest General Health Center is a 352-bed community hospital located in Middleburg Heights, Ohio.One of the last standing community hospitals in Northeast Ohio, we partner with University Hospit...[show_more][last_updated.last_updated_variable_days]
We're changing lives every day.For both our patients and our team members.Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with y...[show_more][last_updated.last_updated_variable_hours]
At Zimmer Biomet, we believe in pushing the boundaries of innovation and driving our mission forward.As a global medical technology leader for nearly 100 years, a patient's mobility is enhanced by ...[show_more][last_updated.last_updated_variable_days]
Registered Nurse / Licensed Practical Nurse.Nurse Supervisor & Medical Director.Path Behavioral Health is a progressive, client-first organization dedicated to improving the lives of individuals an...[show_more][last_updated.last_updated_variable_days]
Apply Job Type Contract Description.Engage Consulting is seeking an experienced Clinical Nurse Consultant for a 1099 contract to support an interim project in the post-acute care space.The ideal ca...[show_more][last_updated.last_updated_30]
The Clinical Manager is responsible for ensuring that patient care is coordinated and managed appropriately.The Clinical Manager is responsible for ensuring that care and services are delivered app...[show_more][last_updated.last_updated_variable_hours]
Beyond Competitive It is no longer ok to just be competitive regarding how we treat our people in everything we do.Our leadership team believes wholeheartedly we need to be beyond competitive and c...[show_more][last_updated.last_updated_30]
A company is looking for a Clinical Admin Manager to oversee compliance, quality assurance, and training within the clinical operations department.
Key Responsibilities Oversee licensing partnersh...[show_more][last_updated.last_updated_1_day]
Engage Consulting is seeking an experienced Clinical Nurse Consultant for a 1099 contract to support an interim project in the post-acute care space.
The ideal candidate will bring strong clinical e...[show_more][last_updated.last_updated_30]
Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family.
Here, you will work alongside a passio...[show_more][last_updated.last_updated_variable_days]
Job Title : Clinical Field Specialist - Nurse.W2 Contract (Temp to perm possibility).Clinical Field Specialist will provide education on products within the Advanced Patient Monitoring portfolio thr...[show_more][last_updated.last_updated_30]
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Clinical Review Nurse
Molina HealthcareCleveland, OH, United States[job_card.full_time]
Sr. Manager, Clinical Care
Strive HealthCleveland, OH, United States[job_card.full_time]
- [promoted]
Clinical Nurse Navigator - Pulmonary Hypertension
University HospitalsCleveland, OH, US[job_card.full_time]
- [promoted]
RN Clinical Nurse-Cardiology Invasive Lab
The MetroHealth SystemCleveland, OH, United States[job_card.full_time]
- [promoted]
Registered Nurse (RN) Clinical Staff Manager
Hospice of the Western ReserveCleveland, OH, US[job_card.full_time]
- [promoted]
- [new]
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical CareGarfield Heights, OH, United States[job_card.full_time]
Midwest Clinical Nurse Manager
BDCleveland,USA OH[job_card.full_time]
- [promoted]
Clinical Program Manager
Applewood CentersCleveland, OH, US[job_card.full_time]
- [promoted]
CLINICAL NURSE
Southwest GeneralCleveland, OH, United States[job_card.full_time]
- [promoted]
- [new]
Clinical Manager
ChenMedMaple Heights, OH, US[job_card.full_time]
- [promoted]
DTS Clinical Sales Manager - France
Zimmer Biomet HoldingsCleveland, OH, US[job_card.full_time]
- [promoted]
Clinical Nurse Specialist
PATH INTEGRATED HEALTHCleveland, OH, United States[job_card.full_time]
Clinical Nurse Consultant-RN
Concept RehabCleveland, OH[job_card.temporary]
- [new]
Hospice Clinical Manager
Affinity Care of OhioCleveland, OH[job_card.full_time]
Clinical Area Manager - Cleveland
Electromed Inc.Cleveland, OH, US[job_card.full_time]
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- [promoted]
Clinical Admin Manager
VirtualVocationsCleveland, Ohio, United States[job_card.full_time]
- [promoted]
Clinical Nurse Consultant-RN
Engage ConsultingCleveland, OH, United States[job_card.temporary]
- [promoted]
Clinical Risk Manager I
Ohio StaffingCleveland, OH, US[job_card.full_time]
Clinical Field Specialist - Nurse
Sunrise SystemsCleveland, Ohio, United States[job_card.temporary]
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Clinical Review Nurse
Molina HealthcareCleveland, OH, United States[job_card.variable_days_ago]
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- [job_card.full_time]
[job_card.job_description]A minimum of 2 years of clinical nursing experience, including at least 1 year in utilization review or related fields. Active and unrestricted Registered Nurse (RN) license. Proficient in ICD-10, CPT coding, and HCPCS. Familiarity with state and federal regulatory frameworks. Strong analytical, problem-solving, and decision-making skills. Excellent organizational and time management abilities. Attention to detail and critical thinking capabilities. Effective verbal and written communication skills. Proficient in Microsoft Office and relevant software applications. Relevant healthcare certifications (e.g., CCC, CMAS, CCM). Nursing experience in critical care, emergency medicine, or pediatrics. Experience in billing and coding.
Job Overview : Join our dynamic team as a Clinical Review Nurse, where you will play a crucial role in evaluating medical claims and supporting internal appeals. This position is essential for ensuring compliance with state and federal regulations, as well as Molina's policies, while promoting high-quality and cost-effective care for our members.
Key Responsibilities :
- Conduct clinical reviews of medical claims, appeals, and previously denied cases, ensuring the medical necessity and accuracy of claims processing.
- Utilize advanced clinical knowledge and regulatory guidelines to assess the appropriateness of services and care levels provided to patients.
- Validate medical records and claims coding to secure proper reimbursement for healthcare providers.
- Handle escalated complaints related to utilization management and long-term services and supports (LTSS).
- Identify and report any quality of care concerns.
- Assist in complex claim reviews and make informed recommendations based on clinical experience.
- Prepare and present cases alongside the chief medical officer for administrative law hearings and other judicial processes.
- Collaborate with medical directors to review clinical guidelines related to denied claims.
- Provide evidence supporting all recommendations regarding payment modifications or denials.
- Act as a clinical resource for utilization management, addressing queries from providers and members.
- Offer training and support to clinical staff.
- Identify special needs members and refer them to appropriate Molina programs as per protocols.
Qualifications : Required :
Preferred :
Compensation : The pay range is $29.05 - $67.97 per hour. Actual compensation may vary based on geographic location, experience, education, and skill level.