Location: METROHEALTH MEDICAL CENTER

Biweekly Hours: 72.00

Shift: day shift 8a-530p

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 opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary:

In cooperation and conjuction with the Director - Care Coordination and Manager - Care Coordination, plans, coordinates, and evaluates all activities impacting utilization review (e.g., the centralized referral/authorization area specifically focusing on payer verification, preadmission processing, authorization, clincial utilization management functions, etc.). Works with the manager to oversee the application of clinical criteria to ensure the correct preauthorization status and level of care. Works with payors and providers to establish/maintain processes that ensures adequate payment of services that is consistent with contractual agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.