Part time- .4 FTE
Hours: Monday AM, Thursday AM, all day Friday
Clinical opportunities exist in Cleveland Clinic Community Health to make this a full time opportunity.
- Review all nurse identified denial of services for medical and prescription for final determination.
- Review all physician/provider requests for increased reimbursement.
- Review all services that do not meet the medical necessity criteria standards.
- Review all requests for new technology procedures.
- Provides consultation to Cleveland Clinic Care Management referral authorization staff, case coordinator nurses regarding medical appropriateness and cost-effectiveness of physician care.
- Provides consultation to Behavioral Health and Pharmacy initiatives for the Cleveland Clinic EHP.
- Educational Requirements: Physician meeting credentialing criteria of the Cleveland Clinic Physician Organization.
- Experience Requirements: At least five years of clinical experience. Preferred minimum of two years of medical management: utilization review, case management, disease management and/or quality improvement activities in an HMO or integrated delivery system setting. Experience is occupational health, workers’ compensation and employee wellness a plus. Preferred Masters prepared in MBA, MPH or MHA.
- Required Licenses and/or Certificates: Board certified in primary specialty.
- Skills and Abilities: In addition to the skills required to manage personnel effectively, this position requires the ability to interface successfully with numerous other practicing and physician executives in a variety of settings.