Cleveland Clinic

• Provide strategic and operational leadership for outpatient Pharmacy Informatics services • Oversee Epic Care Ambulatory, Epic Willow Ambulatory, Epic Beacon, and related technology platforms • Lead workflow optimization and enhancement requests • Partner with Pharmacy Operations, IT, and clinical leaders to improve system performance • Drive governance, change management, and standardization efforts for outpatient pharmacy services

• The Pharmacy Manager – Clinical Informatics provides operational and strategic leadership for enterprise Pharmacy Informatics services across Cleveland Clinic's U.S. and London locations • This role oversees medication order workflows, clinical decision support, smart pump integration, and enterprise medication-use technology. • Responsibilities include directing system optimization, troubleshooting, end-user support, and strategic informatics initiatives • Drive governance, change management, issue resolution, and technology innovation for medication management across the enterprise

Title: PRN Utilization Management RN Reviewer NE Location: Weston United States Job Description: Join Cleveland Clinic Weston Hospital's team of caregivers that remain on the leading edge of technology and education, all while consistently providing patient-centered healthcare. As part of Cleveland Clinic's Florida region, Weston Hospital is recognized as one of the top hospitals in the Miami-Fort Lauderdale and Florida regions. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities, such as admission review, concurrent review, retrospective chart review and clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient's hospital stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review, providing clinical information to payers, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and special projects. This is a regular PRN position, with caregivers working days between 8:00 a.m. - 4:30 p.m. with weekend requirements. This remote role is limited to Florida, Ohio, and Nevada. Candidates must live within one hour of a Cleveland Clinic hospital to be eligible. A caregiver who excels in this role will: - Recommend resource utilization. - Prioritize and organize work to meet changing priorities. - Utilize analytical abilities required to gather data. - Use clinical judgment to apply predetermined criteria or use independent clinical judgment when no predetermined criteria exist to 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 at least 25-30 reviews per day. - Apply medical necessity guidelines accurately to monitor appropriateness of admission and continued stays. - Document appropriately in UM notes to provide evidence that the UR process for the case was followed. - Attend all staff meeting when scheduled to work. - Other duties as assigned. Minimum qualifications for the ideal future caregiver include: - 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) or American Red Cross - Three years of equivalent full-time clinical experience as a Registered Nurse - Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes - Analytical ability to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution - Basic knowledge of medical records coding standards - Awareness of licensing and accreditation standards - Proficient with Microsoft Office - Knowledge of billing practices, identification of billing problems, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings. - 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 - Knowledge of and ability to use multiple Hospital information systems and Department's software - Ability to use copier, fax machine and personal computer Preferred qualifications for the ideal future caregiver include: - Bachelor of science in nursing (BSN) - Case Management Certification (CCM) preferred within first year of eligibility - Prior Utilization Management experience - Case management or ED experience 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. 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.

• Deliver an exceptional experience to patients, families and visitors • Assist with scheduling and pre-registration • Help with MyChart enrollment and visit preparations • Investigate, triage and resolve patient issues using the established HEART model • Create a welcome and professional environment • Perform patient registration, visit preparation, telephone triage, and insurance verification • Enter and maintain confidential patient information • Recruit, enroll and educate patients on MyChart and Appointment Pass

• Manage the daily operations of Utilization Management, which includes concurrent and retrospective utilization review for medical necessity, collaboration and participation with the health care delivery team, review of utilization outcomes and related improvement activities. • Participate in departmental cost budgets and cost containment efforts. • Review and interpret patient population specific financial reports. • Recommend/implement resource utilization. • Prioritize and organize work to meet changing priorities. • Assist Senior Director as needed. • Oversee UM Specialists work load and projects. • Work independently to resolve issues within Utilization Management. • Utilize independent judgment to identify opportunities for improvement and coordinate projects to attain goals. • Provide direction and oversight for the UM Specialists daily activities and complete performance evaluations annually. • Hire and implement disciplinary action when needed. • Solve complex issues within Utilization Management and report results effectively using evidence-based practice framework. • Develop, recommend and initiate corrective action to avoid denials. • Analyze complex data sets to improve patient quality care/ financial outcomes.

Role Description Join Cleveland Clinic Weston Hospital’s team of caregivers that remain on the leading edge of technology and education, all while consistently providing patient-centered healthcare. As part of Cleveland Clinic’s Florida region, Weston Hospital is recognized as one of the top hospitals in the Miami-Fort Lauderdale and Florida regions. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities, such as: - Admission review - Concurrent review - Retrospective chart review - Clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient’s hospital stay or visit Some of the responsibilities of a Utilization Management Specialist include: - Medical record review - Providing clinical information to payers - UM data collection and reporting - Concurrent denials appeals process - Clinical team interaction - Physician Adviser interaction - Special projects This is a regular PRN position, with caregivers working days between 8:00 a.m. – 4:30 p.m. with weekend requirements. This remote role is limited to Florida, Ohio, and Nevada. Candidates must live within one hour of a Cleveland Clinic hospital to be eligible. A caregiver who excels in this role will: - Recommend resource utilization - Prioritize and organize work to meet changing priorities - Utilize analytical abilities required to gather data - Use clinical judgment to apply predetermined criteria or use independent clinical judgment when no predetermined criteria exist to 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 the 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 at least 25-30 reviews per day - Apply medical necessity guidelines accurately to monitor appropriateness of admission and continued stays - Document appropriately in UM notes to provide evidence that the UR process for the case was followed - Attend all staff meetings when scheduled to work - Other duties as assigned Qualifications - 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) or American Red Cross - Three years of equivalent full-time clinical experience as a Registered Nurse - Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes - Analytical ability to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution - Basic knowledge of medical records coding standards - Awareness of licensing and accreditation standards - Proficient with Microsoft Office - Knowledge of billing practices, identification of billing problems, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings - 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 - Knowledge of and ability to use multiple Hospital information systems and Department's software - Ability to use copier, fax machine and personal computer Requirements - Bachelor of science in nursing (BSN) preferred - Case Management Certification (CCM) preferred within first year of eligibility - Prior Utilization Management experience - Case management or ED experience 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. Company Description 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 vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster. Cleveland Clinic is pleased to be an equal employment opportunity employer.

• Conduct customer service and support caregivers on nursing units at Cleveland Clinic Hospitals • Review and communicate staffing and scheduling adjustments encompassing nurse to patient ratios • Proactively generate and review 24-hour staffing projections • Seek coverage via phone calls and/or texts for shifts and special circumstances • Conduct Lack of Work process according to Standard Operating Procedure when necessary to maintain safe and productive staffing • Utilize staffing and scheduling knowledge to identify and resolve complex staffing issues that directly affect patient care • Utilize multiple computer systems to communicate with nursing leadership of all hospitals • Work collaboratively with nurse leadership to review current and anticipated staffing needs • Facilitate scheduling of PRN caregivers and agency caregivers to maintain operations for the assigned units • Complete appropriate documentation utilizing Kronos for caregiver schedule changes • Be a point of contact for unit call offs • Accurately record, document and report call offs according to SOP • Compile ad hoc and scheduled reports for Chief Nursing Offers, Nursing Directors and Nurse Managers • Attend and successfully complete required training

• Prepare timecards for review and final approval by unit management prior to the standardized deadline. • Collaborate with the unit manager to ensure accurate information is received and coded into the Kronos timekeeping system before signing off. • Administer timekeeping responsibilities including correcting missed punches and making updates to employee timecards to ensure accurate accounts of productivity status. • Correct employee timecards and interfaces with payroll department to coordinate time changes to ensure timecards are kept up to date in accordance with wage and labor standards. • Update time and attendance system with timekeeping and pay codes. • Audit time records to ensure hours are recorded correctly including FTE hours, missed punches, absences, planned time off and FMLA hours. • Maintain timekeeping records and supporting documentation.

• Facilitate the transfer of patients from internal and external facilities into the Cleveland Clinic Health System. • Work collaboratively with fellow caregivers to optimize patient placement to maximize enterprise capacity. • Serve as the initial point of contact from external and internal providers and obtain the necessary information to initiate patient transfers into the Cleveland Clinic Health System. • Receive transfer requests from physicians, mid-level providers or representatives from internal and external facilities (e.g., demographic, insurance and clinical data). • Coordinate referrals to appropriate medical service as needed for referred patient. • Connect referring parties with accepting Cleveland Clinic provider to determine appropriateness of transfer. • Perform follow up communication with Financial Counselors, Case Managers and nursing staff to help expedite transfers to the Cleveland Clinic Health system facility. • Collaborate with Patient Flow Coordinators and Access RNs to determine availability of appropriate bed. • Actively participate in the maintenance of 24/7 daily systems to maximize patient flow and optimize bed capacity across the enterprise. • Support centralized communications between referring and accepting provider services (e.g., preparing for and leading bed meetings, ensuring accuracy of electronic patient placement systems data, providing backup for patient placement discussions and decisions across the enterprise).

• Provide education to providers and clinicians to ensure accurate documentation • Review for correct DRG, APC and HCC assignment • Conduct reviews of medical records for patients in outpatient settings • Query providers and medical team members to clarify clinical documentation