Certified Clinical Denial Management Supervisor

Certified Clinical Denial Management Supervisor

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Certified Clinical Denial Management Supervisor, you will be responsible for the day-to-day operations of the Payer Denial Management team, coordinating the work for the team to ensure high-value accounts are prioritized and turnaround times are met, identifying denial trends and process improvement opportunities, and acting as a key resource for the team.

A caregiver in this position works 8:00am – 5:00pm.

A caregiver who excels in this role will:

Oversee the facilitation of the denial and appeal process.

Identify, develop, and apply process improvement methodologies in evaluating and improving appeal outcomes.

Provide direction to department work leads.

Collaborate with Institutes, hospital departments or care management to provide education on identified denial trends.

Establish relationships with payers and collaborate with Market and Network Services.

Address the educational needs of caregivers and ensure consistent application of policies.

Orient and assist in training new caregivers.

Analyze productivity and other outcome measures.

Act as a super user of all hospital billing systems, denial systems or RAC tracking systems.

Provide expertise in the application of InterQual and MCG criteria.

Monitor routine data and complete monthly reports.

Where applicable, serve as a clinical subject matter expert for the team.

Lead and participate in enterprise committee meetings.

Minimum qualifications for the ideal future caregiver include:

Graduate of an accredited school of nursing.

Licensed Registered Nurse (RN) in the State of Ohio.

Five years of utilization management experience and acute med/surg experience.

Strong interpersonal communication, negotiation and critical thinking skills.

Preferred qualifications for the ideal future caregiver include:

Bachelor of Science in Nursing (BSN) or other bachelors degree.

Certification in case management (CCM).

InterQual certification.

Expertise with InterQual and MCG disease management ideologies.

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

Physical Requirements:

Must be able to work well under pressure and maintain a professional demeanor under adverse conditions.

Extensive reading writing, fax machines, computers and copiers.

Sedentary work involves sitting most of the time but may involve walking or standing for briefs periods of time.

Personal Protective Equipment

Follows standard precautions using personal protective equipment as required.

Pay Range

Minimum hourly: $30.41

Maximum hourly: $46.38

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidates actual compensation will be determined after taking factors into consideration such as the candidates work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinics benefits package, which includes among other benefits, healthcare/dental/vision and retirement.

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