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.
Internal Number: EHP
About Cleveland Clinic
Cleveland Clinic is one of the world's largest and busiest health centers. Patients come to Cleveland Clinic from all over the world. We offer advanced treatment for all illnesses and disorders of the body. We enjoy a strong reputation for outstanding quality care. U.S News & World Report has declared that we are the No. 2 hospital in the country. Cleveland Clinic’s heart program has ranked No. 1 in the nation since 1995. Our urology program also ranked No. 1 in the nation, and three of our specialties - gastroentrerology and GI surgery, nephrology, and rheumatology are ranked No. 2.
Eight other Cleveland Clinic specialties are ranked in the Top 10. Cleveland Clinic earned the highest ranking of any Ohio hospital.
Other specialties noted for national excellence include ENT and pediatrics. Cleveland Clinic Children's offers highly specialized pediatric care in a family-centered atmosphere. It has been ranked the best children's hospital in Ohio by Child magazine.
Cleveland Clinic was founded in 1921 as a not-for-profit group practice, integrating clinical and hospital care with research and physician education. In addition to our Cleveland location, we have Clevel...and Clinic Florida, Cleveland Clinic Nevada, Cleveland Clinic Canada, and Cleveland Clinic Abu Dhabi. Cleveland Clinic London is also scheduled to open in February 2021.
Cleveland Clinic has more than 3,600 salaried physicians and scientists on staff, representing approximately 120 specialties and subspecialties. In 2017, we provided a total of 7.6 million outpatient visits, 229,132 acute admissions and observations, and 207,354 surgical cases. Patients came to us from across America and from more than 180 nations. We also lead an extensive system of community hospitals in Northeast Ohio called the Cleveland Clinic Hospitals.
This system is made up of Cleveland Clinic Main Campus, Akron General Hospital, Avon Hospital, Euclid Hospital, Fairview Hospital, Hillcrest Hospital, Lodi Hospital, Lutheran Hospital, Marymount Hospital, Medina Hospital, South Pointe Hospital, and Union Hospital. Ashtabula County Medical Center is also an affiliate of Cleveland Clinic. With approximately 4,500 staffed beds, Cleveland Clinic Hospitals offers broad geographic coverage, a full continuum of care, improved quality and lower cost of care to Northeast Ohio residents.
Cleveland Clinic ranked 6th overall of 11 honorees by Diversity Inc. in 2018. Companies on this list score well in talent pipeline, talent development, leadership commitment, and supplier diversity.