Top 8 Utilization management nurse Jobs in Newark, Oh

Registered Nurse / MDS Coordinator
Confidential —Zanesville, OH
- Full-time
- Anatomy knowledge
- RN License
- Mid-level
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Rapid Response Nurse-Part-time 24, Nights
OhioHealth —Pickerington, OH
- Part-time
- Acute care
- Nursing
- RN License
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Registered Nurse / MDS Coordinator

Confidential
Zanesville, OH

Quick Apply

Job Details

Full-time

Qualifications

Anatomy knowledge
Caregiving documentation requirements
Utilization review
RN License
Coding for hospital billing
MDS
RN experience
Health insurance knowledge
Utilization management
Resource utilization in healthcare
Pediatrics
Care coordination
Medical terminology

Full Job Description

Overview
We are seeking a dedicated and detail-oriented Registered Nurse / MDS Coordinator to join our healthcare team. In this vital role, you will oversee the comprehensive assessment and documentation of patient care needs, ensuring compliance with regulatory standards such as NCQA (National Committee for Quality Assurance) and Medicare requirements. Your expertise will support clinical documentation improvement, utilization review, and case management processes to optimize patient outcomes and facility efficiency. This position offers an exciting opportunity to apply your nursing skills in a dynamic environment that values accuracy, compliance, and compassionate care.

Duties

Lead the development, review, and updating of Minimum Data Set (MDS) assessments to accurately reflect patient conditions and care plans.
Coordinate interdisciplinary team efforts to ensure timely completion of MDS schedules, discharge planning, and care documentation aligned with federal and state regulations.
Conduct thorough medical record reviews, ensuring accuracy in medical documentation, coding (ICD-10, CPT), and compliance with HIPAA standards.
Collaborate with clinical staff to improve clinical documentation practices, supporting reimbursement accuracy and quality reporting.
Utilize electronic health record (EHR) systems such as Epic, Cerner, Athenahealth, or eClinicalWorks to manage patient data efficiently.
Perform utilization management activities including review of hospital stays, outpatient services, hospice care, emergency medicine cases, and inpatient admissions at Level I or Level II trauma centers.
Support discharge planning by coordinating with case management teams to facilitate smooth transitions across care settings including home care and outpatient clinics.
Maintain up-to-date knowledge of healthcare regulations related to Medicare, Managed Care organizations, NCQA standards, and HIPAA compliance.

Requirements

Valid Registered Nurse (RN) license with current state licensure.
Proven experience with MDS coordination in nursing homes or long-term care facilities.
Strong knowledge of ICD-10/ICD coding, CPT coding, DRG assignments, and medical terminology.
Experience working with EMR/EHR systems such as Epic, Cerner, Athenahealth or eClinicalWorks is highly preferred.
Background in acute care settings including ICU experience or Level I/II trauma center experience is advantageous.
Familiarity with managed care processes, utilization review, clinical documentation improvement initiatives, and discharge planning procedures.
Excellent understanding of physiology, anatomy, pharmacology, and patient care principles across diverse populations including pediatrics or primary care settings.

Work Location: In person

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utilization management nurse jobs in newark, oh

Registered Nurse / MDS Coordinator

Rapid Response Nurse-Part-time 24, Nights

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