Top 10 Utilization review nurse Jobs in Toledo, Oh

MDS Coordinator- LPN or RN $40-$50/hr based on experience
Merit House Rehab and Nursing —Toledo, OH
- $40 - $50 an hour
- Full-time
- Background check
- Nursing
- Anatomy knowledge
- Health insurance
- Dental insurance
Quick Apply
1d
RN Field Case Manager
Hope At Home Health Care —Monroe, MI
- Up to $100,000 a year
- Weekends as needed
- Nursing
- Management
- RN License
- Health insurance
- Flexible spending account
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Medicaid Medical Review RN (Medical Reviewer III)
CoventBridge Group —United States
- $78,000 - $85,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance
3d

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Senior Compliance Auditor - RN
Elara Caring —Toledo, OH
Attends audit findings calls, as needed, and assists in the development of corrective action plans, ensuring implementation of corrective actions in a timely…
$80,000 - $90,000 a year
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16h
Supervisor - Inpatient Clinical Documentation Integrity
University of Michigan —Ann Arbor, MI
Bachelors degree in Health Information Management, Nursing, healthcare administration, or a related healthcare field, or an equivalent combination of education…
6d

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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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International SOS —Columbus, OH
Valid Ohio State NP license. This role combines advanced clinical practice with operational oversight, including patient assessment, diagnosis, treatment, and…
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MDS Coordinator- LPN or RN $40-$50/hr based on experience

Merit House Rehab and Nursing
Toledo, OH

Quick Apply

Job Details

Full-time
$40 - $50 an hour
1 day ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Anatomy knowledge
Teamwork
Long-term care regulations
Medicare
RN License
CMS
Regulatory compliance
Coding for hospital billing
CMS regulatory compliance
Medicare regulations
Health information regulatory compliance
Organizational skills
Centers for Medicare & Medicaid Services (CMS) billing regulations
Document quality checks
Medicaid regulations
Health information management
Medical data abstraction
Clinical documentation standards
Medical terminology
Medical record review for billing accuracy
Documentation review for coding accuracy

Full Job Description

Overview

We are seeking a dedicated and detail-oriented MDS Coordinator—either Licensed Practical Nurse (LPN) or Registered Nurse (RN)—to join our dynamic healthcare team. In this vital role, you will lead the comprehensive assessment and documentation process for long-term care residents, ensuring compliance with federal and state regulations, including CMS (Centers for Medicare and Medicaid Services) standards. Your expertise will support optimal patient care, accurate medical records management, and seamless coordination across clinical teams. This position offers an exciting opportunity to make a meaningful impact on patient outcomes while working in a collaborative, fast-paced environment.

Duties

Conduct thorough Minimum Data Set (MDS) assessments for residents in accordance with clinical documentation standards and regulatory requirements.
Review and analyze medical records, clinical documentation, and care plans to ensure accuracy and completeness.
Collaborate with interdisciplinary teams—including nursing, therapy, social services, and physicians—to develop individualized care plans aligned with MDS data.
Ensure timely completion of MDS schedules, including scheduled assessments and follow-up evaluations.
Utilize electronic health record (EHR) systems such as Epic, Cerner, or Athenahealth to document assessments, coding, and care coordination activities.
Apply medical coding expertise—including CPT coding, ICD-9/10 coding, DRGs (Diagnosis-Related Groups), and ICD coding—to facilitate accurate reimbursement and compliance.
Stay current with healthcare regulations related to long-term care, Medicare/Medicare regulations, HIPAA privacy standards, and CMS guidelines to ensure ongoing compliance.
Participate in quality assurance activities like clinical documentation improvement (CDI) initiatives and utilization management reviews to optimize patient care documentation.

Requirements

Valid LPN or RN license with current state licensure.
Proven experience in long-term care settings such as nursing homes or skilled nursing facilities.
Familiarity with EMR/EHR systems including PCC proficiency in Microsoft Office is preferred.
Strong knowledge of Medicare regulations, CMS guidelines, NCQA standards, and long-term care regulations.
Experience with medical documentation review, medical coding (including ICD-10/ICD-9/CPT), and DRG assignment.
Critical care experience or ICU background is highly desirable; inpatient or acute care experience is a plus.
Knowledge of physiology, anatomy, medical terminology, and healthcare policies related to patient care management.
Excellent organizational skills with the ability to manage multiple assessments simultaneously while maintaining accuracy.
Strong communication skills to collaborate effectively across multidisciplinary teams and ensure compliance with health regulation policies.

Join us in this rewarding role where your expertise will directly influence quality patient outcomes! We are committed to fostering a supportive environment that values your skills and dedication while providing opportunities for professional growth within the healthcare industry.

Pay: $40.00 - $50.00 per hour

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Experience:

MDS: 1 year (Required)

License/Certification:

LPN (Required)
RN (Preferred)

Ability to Commute:

Toledo, OH 43612 (Required)

Work Location: In person

Quick Apply

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utilization review nurse jobs in toledo, oh

MDS Coordinator- LPN or RN $40-$50/hr based on experience

RN Field Case Manager

Medicaid Medical Review RN (Medical Reviewer III)

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