Because our nursing team
will bring out your best
Utilization Management Specialist
Req#: 294936
Location:
Facilities: Remote Location
Professional Area: Nursing Non Patient Care
Department: 4750 NRS-Enterprise Utilization Mgmt-Nursing Institute
Job Code: 0008IR
Schedule: PRN
Shift: Days
Apply Today!
FL based ONLY: Must be FL resident
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 a Utilization Management Specialist, you will perform UM activities, such as admission, concurrent, retrospective chart and clinical systems reviews to measure clinical performance and issues that affect reimbursement for hospital stays or visits. This role is essential in the overall organizational and functional operations, helping advance and enhance the patient experience and delivery of care across the hospital.
A caregiver in this position works remotely (FL based ONLY) from 8:00AM – 4:30PM, with weekend requirements.
A caregiver who excels in this role will:
- Recommend resource utilization.
- Prioritizes and organizes work to meet changing priorities.
- Utilizes analytical ability required to gather data, apply predetermined criteria, identify problems, facilitate resolution, recommend corrective action and report results effectively.
- Use independent clinical judgment in reviewing records to determine status of patients stay, if proper procedures have been followed, seriousness of incidents and ability to identify need for and participate in focused reviews, special projects and identify opportunities for improvement.
- Make recommendations regarding appropriateness of the treatment plan for continued stay and safety of the discharge plan.
- Achieve a minimum of 85% on IRR quarterly.
- Complete Utilization Management for assigned patients with a minimum of 25-30 reviews per day.
- Apply medical necessity guidelines accurately to monitor appropriateness of admission and continued stays.
- Maintain and support collaborative relationships with RN Case Manager, Physicians and the multidisciplinary team.
- Document appropriately in UM notes to provide evidence that the UR process for the case was followed.
Minimum qualifications for the ideal future caregiver include:
- A caregiver in this position works remotely (FL based ONLY)
- Graduate of an accredited School of Nursing
- Current state licensure as a Registered Nurse (RN)
- Basic Life Support (BLS) Certification through the American Heart Association (AHA)
- Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures and basic disease processes
- Three years of equivalent full-time clinical experience as a Registered Nurse
- Analytical ability required to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution
- Basic knowledge of medical records coding standards
- Proficiency with Microsoft Office
- Knowledge of billing practices, identification of billing problems and adequacy of documentation
- Knowledge and experience with Care Guidelines, Medical Necessity Criteria and/or other UM criteria sets
- Ability to assess medical records and make determinations on length of stay and proper procedures in accordance with policies and procedures
- Demonstrated competence in all areas identified in the Competencies, Dimensions, Problem solving, and Information Management sections
- Knowledge of and ability to use multiple Hospital information systems and Department's software
Preferred qualifications for the ideal future caregiver include:
- Case Management Certification (CCM)
- Prior Utilization Management experience
- Experience doing Utilization Reviews through NCG or Interqual
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:
- Requires walking, sitting, and/or standing for long periods of time.
- Requires constant attention to detail, reading of medical records, and meeting deadlines.
- Works in an environment where there is some discomfort due to dust, noise, temperature.
Personal Protective Equipment:
- Follows standard precautions using personal protective equipment.
CCIR CBA Bidding Date 04/09/2025-04/16/2025
Pay Range
Salaries [which may be] shown on independent job search websites reflect various market averages and do not represent information obtained directly from The Cleveland Clinic. Because we value each individual candidate, we invite and encourage each candidate to discuss salary/hourly specifics during the application and hiring process.
Application Process
At Cleveland Clinic, we strive to make your journey to becoming a contributing caregiver as streamlined as possible. Here’s how it works.
Step 1: Apply
You can begin the application process by clicking on the “Start Application” button below. We highly recommend that you apply with a resume so we can understand your professional background, including education, work and volunteer experience(s). When you apply, you will be required to answer a few Human Resources policy questions. Some positions require additional prescreening questions, including years of experience and specific questions related to the minimum qualifications of the job.
Step 2: Screening
A Cleveland Clinic caregiver will carefully review your application and notify you of the next steps in the process. This notification may be through email, text message or a phone call. In addition, you can expect to complete some prescreening questions with a recruiter or you may be asked to answer additional questions via a pre-recorded video interview.
Step 3: Interview
If qualified for the position, you will receive a text or email with the next steps. Potential next steps could include scheduling either a live, in-person interview or completing an on-demand, recorded interview. During the interview process, your recruiter will share information about when you can expect to receive any relevant feedback or information regarding potential next steps.
Step 4: Hire
If you are hired and accept an offer for the position you applied to, you will receive a formal offer letter to initiate the new hire onboarding process.
After you accept your formal offer letter, you can expect your recruiter to review the following information with you:
- Confirmation of HR and Occupational Health appointments, including the date, time, location and required pre-work for the appointments.
- A background check will be initiated by our third-party vendor, Certiphi.
- Any additional orientation information specific to your new position.
Join Us in Continuously Advancing Nursing Excellence
At Cleveland Clinic, we are focused on continuously elevating the practice and profession of nursing. The Stanley Shalom Zielony Institute for Nursing Excellence oversees and empowers the practice, education and professional development of nearly 35,000 nurse caregivers in the Cleveland Clinic health system. Our hospitals and surgical nurses provide care for patients in 6,496 hospital beds and 240+ operating rooms throughout the Cleveland Clinic enterprise. Our locations include family health centers, 14 regional hospitals in Ohio, five regional hospitals in Florida, a location in Nevada and three international locations – Abu Dhabi, Canada and London. Our dynamic and technologically advanced environment and commitment to your ongoing learning and growth allow our nurses to remain professionally challenged as they shape their nursing careers.
Nursing Support Career Paths
Working for Cleveland Clinic is more than just a job – it can be a launching point for an exceptional career. Nursing Support plays a critical role in ensuring excellent care and positive patient experiences. There is a wide range of roles to contribute to this vital team. We are committed to providing you with the resources and support you need to define and follow your own unique career path, whether in Nursing Support or other areas of our organization. Nursing Support opportunities include:
Our Culture
Exceptional patient care takes exceptional caregivers. We have created an environment where caregivers feel like family. It is a place noted for constant learning, intense collaboration and caring the right way for the right reasons. Here, you’ll take on every challenge with our unwavering support.
At Cleveland Clinic, we have made it our mission to care for life, research for health and educate those who serve. These principles have always been our North Star. And it has led us to deliver an exceptional level of care alongside some of the industry’s most gifted, hardworking caregivers. Our mission has also helped us define our vision: to be the best place to receive care anywhere and the best place to work in healthcare. In delivering care, we recognize four priorities:
- Care for patients as if they are your own family.
- Treat fellow caregivers as if they are your own family.
- Demonstrate commitment to the communities we serve.
- Treat the organization as your home.
Our unique working environment is built on a strong foundation of unifying beliefs that includes:
- Learning from experiences – We are a world-class hospital with a unique and varied caseload. Here, each moment is a new chance to be challenged, to learn and to grow as a caregiver. Browse our stories to see firsthand how experiences build experience.
- Developing our people – We are always learning. Our multi-disciplinary teams and knowledge-sharing allow our caregivers to be students of each other. Trainings, courses and mentorships round out our culture of learning. Our Career Growth Pathways is a suite of resources that helps caregivers enrich their current skill set, explore other roles, move laterally throughout the organization or grow vertically within their team. As they further their careers, caregivers can move into leadership roles in their discipline. Our Mandel Global Leadership & Learning Institute (GLLI) delivers experiential learning, simulations, assessments and research-driven content to help you progress into a leader.
- Caring for our caregivers – Our Office of Caregiver Experience (OCE) supports the emotional, physical, spiritual and social well-being of caregivers through multiple initiatives, resources and events.
Cleveland Clinic is an organization where we support one another, our patients and the communities we serve. It takes each of us to foster a sense of belonging and mutual respect. Together, we will continue to build a culture of excellence, supporting one another to feel empowered and valued. Cleveland Clinic remains committed to:
- Having a workforce, including our vendors and suppliers, that reflects the communities we serve – We do this without discrimination or preference based on race, sex or other similar factors.
- Following our hiring practices – This includes skills-based hiring, identifying robust and new talent sources and ensuring that adequate and equitable career pathways for advancement exist for all caregivers.
- Continuing our Employee Resource Groups (ERGs) – These important groups, open to all caregivers, offer an opportunity to relate to, grow with and support one another.
- Providing the most appropriate education to advance safe, highly reliable care – This includes support and programs that meet the unique needs of our patients and achieve the best possible outcomes.
We value your consistent dedication to exceptional patient care. We recognize and respect your life away from work. Being able to enjoy a fulfilling life can recharge you and enable you to be an even more effective contributor in your career. We are proud to provide a generous Paid Time Off (PTO) program for regular full-time, part-time and weekender benefits-eligible caregivers where they can accrue time off for vacations, holidays, sickness and personal days.
At Cleveland Clinic, we have made it our mission to care for life, research for health and educate those who serve. These principles have always been our North Star. And it has led us to deliver an exceptional level of care alongside some of the industry’s most gifted, hardworking caregivers. Our mission has also helped us define our vision: to be the best place to receive care anywhere and the best place to work in healthcare. In delivering care, we recognize four priorities:
- Care for patients as if they are your own family.
- Treat fellow caregivers as if they are your own family.
- Demonstrate commitment to the communities we serve.
- Treat the organization as your home.
Our unique working environment is built on a strong foundation of unifying beliefs that includes:
- Learning from experiences – We are a world-class hospital with a unique and varied caseload. Here, each moment is a new chance to be challenged, to learn and to grow as a caregiver. Browse our stories to see firsthand how experiences build experience.
- Developing our people – We are always learning. Our multi-disciplinary teams and knowledge-sharing allow our caregivers to be students of each other. Trainings, courses and mentorships round out our culture of learning. Our Career Growth Pathways is a suite of resources that helps caregivers enrich their current skill set, explore other roles, move laterally throughout the organization or grow vertically within their team. As they further their careers, caregivers can move into leadership roles in their discipline. Our Mandel Global Leadership & Learning Institute (GLLI) delivers experiential learning, simulations, assessments and research-driven content to help you progress into a leader.
- Caring for our caregivers – Our Office of Caregiver Experience (OCE) supports the emotional, physical, spiritual and social well-being of caregivers through multiple initiatives, resources and events.
Cleveland Clinic is an organization where we support one another, our patients and the communities we serve. It takes each of us to foster a sense of belonging and mutual respect. Together, we will continue to build a culture of excellence, supporting one another to feel empowered and valued. Cleveland Clinic remains committed to:
- Having a workforce, including our vendors and suppliers, that reflects the communities we serve – We do this without discrimination or preference based on race, sex or other similar factors.
- Following our hiring practices – This includes skills-based hiring, identifying robust and new talent sources and ensuring that adequate and equitable career pathways for advancement exist for all caregivers.
- Continuing our Employee Resource Groups (ERGs) – These important groups, open to all caregivers, offer an opportunity to relate to, grow with and support one another.
- Providing the most appropriate education to advance safe, highly reliable care – This includes support and programs that meet the unique needs of our patients and achieve the best possible outcomes.
We value your consistent dedication to exceptional patient care. We recognize and respect your life away from work. Being able to enjoy a fulfilling life can recharge you and enable you to be an even more effective contributor in your career. We are proud to provide a generous Paid Time Off (PTO) program for regular full-time, part-time and weekender benefits-eligible caregivers where they can accrue time off for vacations, holidays, sickness and personal days.
Benefits Offerings
Our caregivers deliver the best outcomes for our patients across each of our facilities. We are committed to providing them with the kind of exceptional care they bring to our patients. Caregivers like you come to work each day with a passion for what you do. So, we are always focused on fueling that passion, empowering you to be your best both inside our hospitals and in your life. Our outstanding, comprehensive offerings are an investment in your health, well-being and future. Explore the following benefits and get a closer look at how we’re focused on what matters most to you.
We offer the following choices to cover your health, dental and vision care as well as life insurance.
- Health Plan Options – You have the choice between two comprehensive Cleveland Clinic Employee Health Plan options: EHP and EHP Plus. Both plans are administered by Aetna and feature minimal copays for in-network care. Although the benefit designs of EHP and EHP Plus are identical, they differ in their provider network size, with EHP offering a narrow network and EHP Plus providing access to the wide Aetna Open Access Select network. Both plans include access to Cleveland Clinic providers. The health plan also offers Healthy Choice, a voluntary program where participants earn premium discounts for achieving wellness goals.
- Dental Care – Four plan options administered by Cigna are available.
- Vision Care – Two plan options administered by EyeMed are available.
- Flexible Spending Accounts – Healthcare and Dependent Care FSAs are available to help you pay for eligible expenses with pre-tax dollars.
- Life Insurance – Employer-paid life insurance equals 1x your annual salary with an option to purchase supplemental life insurance up to 10x your salary. You may also purchase dependent life insurance for a spouse and dependent children
- Short- and Long-term Disability Coverage – Short-term disability is available after one continuous year of regular full-time service; long-term disability begins after 90 days.
Because financial security is essential to a secure retirement, we sponsor a comprehensive retirement program to help you build for your financial future:
- Cleveland Clinic Investment Pension Plan offers eligible employees an excellent opportunity to build a retirement account for the future. It is fully funded by Cleveland Clinic and equal to 2.5% of your salary (increasing with more years of service).
- The 401(k) / 403(b) Plan also provides an important source of retirement savings. It allows participants to take responsibility for their financial future by making retirement savings a part of their normal routine while working. In addition to your contributions to the plan, Cleveland Clinic matches a portion of your contributions (50% on up to your first 6% in contributions).
- Paid Time Off (PTO) – Eligible caregivers receive Paid Time Off (PTO) that can be allotted toward vacation, holidays, sick time, etc.
- Caregiver discounts – We offer discounted rates for auto, home and pet insurance, identify theft protection and more.
- Adoption assistance – We provide financial assistance of up to $5,000/per child ($10,000 maximum lifetime benefit) for caregivers who choose to legally adopt a child.
- Employee Assistance Program – The Program provides free, confidential short-term counseling for caregivers and their families, whether for relationships or legal challenges.
- Employee Hardship Fund – This fund provides aid for caregivers experiencing unexpected financial difficulties.
- Paid maternity and parental leave – You will enjoy up to eight consecutive weeks for maternal care after the birth of your child to bond with your baby and up to four weeks for parental care.
We offer the following choices to cover your health, dental and vision care as well as life insurance.
- Health Plan Options – You have the choice between two comprehensive Cleveland Clinic Employee Health Plan options: EHP and EHP Plus. Both plans are administered by Aetna and feature minimal copays for in-network care. Although the benefit designs of EHP and EHP Plus are identical, they differ in their provider network size, with EHP offering a narrow network and EHP Plus providing access to the wide Aetna Open Access Select network. Both plans include access to Cleveland Clinic providers. The health plan also offers Healthy Choice, a voluntary program where participants earn premium discounts for achieving wellness goals.
- Dental Care – Four plan options administered by Cigna are available.
- Vision Care – Two plan options administered by EyeMed are available.
- Flexible Spending Accounts – Healthcare and Dependent Care FSAs are available to help you pay for eligible expenses with pre-tax dollars.
- Life Insurance – Employer-paid life insurance equals 1x your annual salary with an option to purchase supplemental life insurance up to 10x your salary. You may also purchase dependent life insurance for a spouse and dependent children
- Short- and Long-term Disability Coverage – Short-term disability is available after one continuous year of regular full-time service; long-term disability begins after 90 days.
Because financial security is essential to a secure retirement, we sponsor a comprehensive retirement program to help you build for your financial future:
- Cleveland Clinic Investment Pension Plan offers eligible employees an excellent opportunity to build a retirement account for the future. It is fully funded by Cleveland Clinic and equal to 2.5% of your salary (increasing with more years of service).
- The 401(k) / 403(b) Plan also provides an important source of retirement savings. It allows participants to take responsibility for their financial future by making retirement savings a part of their normal routine while working. In addition to your contributions to the plan, Cleveland Clinic matches a portion of your contributions (50% on up to your first 6% in contributions).
- Paid Time Off (PTO) – Eligible caregivers receive Paid Time Off (PTO) that can be allotted toward vacation, holidays, sick time, etc.
- Caregiver discounts – We offer discounted rates for auto, home and pet insurance, identify theft protection and more.
- Adoption assistance – We provide financial assistance of up to $5,000/per child ($10,000 maximum lifetime benefit) for caregivers who choose to legally adopt a child.
- Employee Assistance Program – The Program provides free, confidential short-term counseling for caregivers and their families, whether for relationships or legal challenges.
- Employee Hardship Fund – This fund provides aid for caregivers experiencing unexpected financial difficulties.
- Paid maternity and parental leave – You will enjoy up to eight consecutive weeks for maternal care after the birth of your child to bond with your baby and up to four weeks for parental care.
Ohio
Whether it’s in our hometown of Cleveland, throughout surrounding counties or across the state, we offer abundant opportunities all around Ohio. This includes both hospitals and outpatient facilities. Ohio features an incredible diversity of lifestyle options – from up-and-coming neighborhoods to historic suburbs and big-city excitement to small-town charm. Grab a bite, catch a game or enjoy the vibrant outdoors — you’ll never run out of things to do. Ohio also boasts a robust economy, excellent schools, affordable housing and much more.
Caregiver Stories
We all have an important story to tell. Our shared passions and experiences connect us and inspire us to be our best.
Assistant Manager, Pharmacy Operations Proves College isn’t the Only Road to Success
For Cleveland Clinic Recruiter Leyla Aktekin, one of her greatest moments came when she helped Carlos Del Rio join the Cleveland Clinic caregiver family, with the help of Carlos' wife, Norma (who was already a caregiver).
Registered Nurse Describes Her Role as Vocation, Not Occupation
If you ask Caitlin Schurch, a Recruiter at Cleveland Clinic, she’d tell you her mom “was put on earth to be a nurse” and “would do this work for free.” There's a lot of truth in her statements, since Ann Schurch used to think all kids took care of their elderly neighbors.
Join our Community!
Creating a profile in Cleveland Clinic’s Talent Community will allow our recruitment team to support your job search and identify the right opportunities for you. We will send out email job alerts and upcoming events based on your individual career background and objectives.
Please click below and complete the form to opt in to our Talent Community.
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 drug-free environment. All offers of employment are followed by testing for controlled substances.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining 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.