Top 5 Mds nurse Jobs in Melbourne, Fl

Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
MDS Coordinator RN (Registered Nurse) Licensed Practical Nurse (LPN)
Viera Health & Rehabilitation Center —Melbourne, FL
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Paid holidays
- Disability insurance
Quick Apply
MDS Coordinator (LPN or RN)
Avante at Melbourne —Melbourne, FL
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Paid holidays
- Health insurance
Quick Apply
Director of MDS - RN Lead
Atlantic Shores Nursing & Rehab Center —Melbourne, FL
- Background check
- Nursing
- RN License
- Paid holidays
- Health insurance
Quick Apply

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MDS Coordinator/RN - Full-time - Weekdays
Willow Brook Home —Columbus, OH
Active RN license in Ohio. RN (or LPN) license in good standing (Required). Willow Brook Home is seeking a full-time MDS Coordinator to support our 50-bed care…
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MDS Nurse Transition Leader
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mds nurse jobs near melbourne, fl

Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Florida

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Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Pre-authorization review for utilization management
Productivity software

Full Job Description

JOB DESCRIPTION

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

Utilization Management (UM) experience highly preferred.

#PJHS3

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

Refine Your Search

mds nurse jobs in melbourne, fl

Care Review Clinician (RN) - Remote in FL

MDS Coordinator RN (Registered Nurse) Licensed Practical Nurse (LPN)

MDS Coordinator (LPN or RN)

Director of MDS - RN Lead

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