Top 8498 Rn Utilization Management Jobs

Registered Nurse (RN) Clinical Reimbursement Specialist | Long-term care
Avera Health —Sioux Falls, SD
- $78,000 - $116,480 a year
- Online Application
- Hybrid work
- Nursing
- OSHA
- RN License
- Paid time off
Quick Apply
Utilization Review Nurse (RN)
Lighthouse Care Center of Augusta —Augusta, GA
- Full-time
- Nursing
- Psychiatry
- RN License
- Health insurance
- Dental insurance
Quick Apply
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Utilization Review Nurse
University Medical Center of Southern Nevada —Las Vegas, NV
- $40.72 - $63.12 an hour
- Weekends as needed
- Nursing
- RN License
- Office
- Health insurance
- Dental insurance
Quick Apply
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
Quick Apply
Utilization Management Registered Nurse
Humana —South Carolina
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
RN - Utilization Management - MGH
The General Hospital Corporation —Boston, MA
- $41.72 - $105.65 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Experience equivalent to degree accepted
- Opportunities for advancement
Quick Apply
4d
Utilization Review RN
Providence —Mission Hills, CA
- $57.28 - $88.92 an hour
- Per diem
- Hybrid work
- Nursing
- RN License
- Medical office experience
- Paid parental leave
- Paid holidays
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
13d
RN - Utilization Management
Piedmont Healthcare Inc. —Atlanta, GA
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
3d
Utilization Review RN - Case Management
Swedish Health Services —Seattle, WA
- $52.26 - $81.13 an hour
- Day shift
- Nursing
- RN License
- Hospital
- Paid parental leave
- Paid holidays
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
Utilization Management Registered Nurse RN
Trinity Health Of New England —Hartford, CT
- Full-time
- Hybrid work
- Nursing
- RN License
- Bachelor of Science
8d
Utilization Management RN (Hybrid)
TEXASCONNECT INC —Dallas, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Relocation assistance
Utilization Management Nurse (RN)
Saint Francis Health System —Oklahoma City, OK
- Part-time
- Microsoft Word
- Nursing
- Microsoft Excel
Care Manager RN - Utilization Management (UM) Remote
Highmark Inc. —Pennsylvania
- $68,400 - $105,900 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
10d
UTILIZATION REVIEW NURSE - RN
Nexus Health Systems Ltd —Houston, TX
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply

I want to receive the latest job alert for Rn Utilization Management

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Rn Utilization Management jobs near

Registered Nurse (RN) Clinical Reimbursement Specialist | Long-term care

Avera Health -
Sioux Falls, SD

Quick Apply

Job Details

Full-time
$78,000 - $116,480 a year

Benefits

Paid time off

Qualifications

RN License
Team leadership
RAC-CT
Clinical staff development programs
Long-term care facility experience
Team development
Clinical staff training
Clinical training
Clinical staff mentoring
Team training
Leading team collaboration initiatives

Full Job Description

Location:

Avera at Home Sioux Falls

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$78,000.00 - $116,480.00

Position Highlights

Must have long-term care experience.

Hybrid position with some travel involved

RN-MDS RAC certified within 6 months.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible for ensuring accurate clinical documentation, assessment and Minimum Data Set ("MDS") coding to support appropriate reimbursement. This role blends strong clinical expertise with regulatory knowledge and analytical skills. This role will oversee compliance, accuracy and optimization of clinical reimbursement strategies for the LTC Division as well as clinical reimbursement compliance and overarching MDS support to teams across Avera.

What you will do

Maintains knowledge of federal regulations, practice standards, and procedures, as well as guidelines pertaining to the RAI process. Develop division strategies for maximizing reimbursement for PDPM, Managed Care and other payer models.
Utilizes clinical judgement and nursing process to be a resource for Nurse Assessment Coordinators, Interdisciplinary team members and LTC Leaders. Develops strategies for maximizing reimbursement under PDPM, Managed Care and other payer models.
Partners with payor contracting on Managed Care/ACO contract utilization and ensures facilities adhere to payer guidelines, timely filing requirements, and pre-authorization processes.
Audits and implements action plans to improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessment.
Monitors facility schedules for timely and complete MDS data submission as per Federal, State, and other payor requirements.
Analyzes reimbursement trends, identify deviations, implement corrective action plans through utilization of system data and analytic resources.
Acts as a liaison between facilities, finance, MDS, nursing, and system resources to ensure accurate reimbursement levels.
Provides ongoing operational support and guidance to facilities regarding denial management, appeals, and reimbursement strategies.
Leads the division efforts to implement best practices for accurate capture of the data elements of the Minimum Data Set (MDS), which is the key driver of the care plan, quality measures and reimbursement programs.
Must be willing to travel.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

Registered Nurse (RN) - Board of Nursing An active license in the state of practice Upon Hire and
Resident Assessment Coordinator - Certified (RAC-CT) - American Association of Post-Acute Care Nursing (AAPACN) An active certification by AAPACN or another approved certification agency to ensure knowledge of clinical assessment and care planning, completion of the MDS, and the regulatory body surrounding the RAI/MDS process within 180 Days
Strong leadership and communication skills with the ability to train and mentor teams

Preferred Education, License/Certification, or Work Experience:

Bachelor's
Extensive knowledge of Medicare, Medicaid, PDPM, Managed Care, QM, and CMI reimbursement systems
Strong expertise in MDS processes, including completion, regulatory compliance
Regional MDS experience
Proficiency in analyzing reimbursement trends, auditing, and implementing performance improvements

Expectations and Standards

Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
Promote Avera’s values of compassion, hospitality, and stewardship.
Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
Maintain confidentiality.
Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

PTO available day 1 for eligible hires.
Up to 5% employer matching contribution for retirement
Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [email protected].

Quick Apply

Refine Your Search

Rn Utilization Management jobs

Registered Nurse (RN) Clinical Reimbursement Specialist | Long-term care

Utilization Review Nurse (RN)

RN Utilization Management

Utilization Management Nurse

Utilization Review Nurse

Concurrent Utilization Review Nurse, RN

Utilization Management Nurse

Remote Home Health RN – Medical Claims Reviewer

Utilization Management Registered Nurse

RN - Utilization Management - MGH

Utilization Review RN

Denials & Appeals Administrator (RN)

RN - Utilization Management

Utilization Review RN - Case Management

Claims - Care Manager, RN, Claims

Utilization Management Registered Nurse RN

Utilization Management RN (Hybrid)

Utilization Management Nurse (RN)

Care Manager RN - Utilization Management (UM) Remote

UTILIZATION REVIEW NURSE - RN

I want to receive the latest job alert for Rn Utilization Management

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected