Top 3140 Utilization review nurse (rn) Jobs

MDS Coordinator, RN
Confidential —Spartanburg, SC
- Full-time
- Background check
- Anatomy knowledge
- Skilled nursing facility
- Free parking
- Disability insurance
Quick Apply
Quality Integrator (RN) (4973) - Region 1
SIU Medicine —Springfield, IL
- $4,805.66 - $5,285.88 a month
- Day shift
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Disability insurance
Clinical Review and Appeals Specialist
Life Care Centers of America —Cleveland, TN
- Weekends as needed
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse, Care Management
Boston Medical Center —Boston, MA
- Full-time
- Nursing
- RN License
- Writing skills
Utilization Management Outpatient Authorization Nurse
Champion Health Plan is a Medicare Advantage Prescription Drug HMO C-SNP serving Medicare beneficiaries with End-Stage Renal Disease. —Long Beach, CA
- From $67,000 a year
- Full-time
- Nursing
- LVN
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Telephonic Registered Nurse Clinical Reviewer - EviCore - Remote
The Cigna Group —Remote
- $31 - $52 an hour
- 8 hour shift
- Remote
- Nursing
- RN License
- Computer literacy
- Paid holidays
- Health insurance
11h
Utilization Management Nurse Consultant
CVS Health —Kentucky
- $26.01 - $74.78 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
3d
Clinical Claims Review Nurse
CVS Health —Florida
- $26.01 - $68.55 an hour
- Full-time
- Remote
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
3d
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Medical Review Nurse- Stop Loss
Roundstone —Rocky River, OH
- $80,000 - $85,000 a year
- Full-time
- Hybrid work
- Background check
- Nursing
- Mid-level
- Health savings account
- Disability insurance
Quick Apply
Utilization Review Nurse
HAMASPIK CHOICE INC —Spring Valley, NY
- $45 - $47 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Utilization Review RN
Memorial Health —Springfield, IL
- $32.95 - $52.73 an hour
- Full-time
- Acute care
- Nursing
- RN License
Utilization Management- RN
South Country Health Alliance —Medford, MN
- $34.39 - $47.94 an hour
- Weekends as needed
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
4d
Utilization Review Nurse (Medicare)
HAMASPIK CHOICE INC —Spring Valley, NY
- $41 - $47 an hour
- Full-time
- Nursing
- RN License
- Mid-level
Quick Apply
Utilization Review Coordinator
Neuropsychiatric Hospitals —Huber Heights, OH
- Full-time
- Nursing
- Psychiatry
- Mid-level
- Health insurance
- Dental insurance
Nurse Case Manager, Utilization Management
1199SEIU Family of Funds —New York, NY
- $89,400 - $106,100 a year
- Full-time
- Nursing
- RN License
- Mid-level
Utilization Review RN
Providence Health and Services —Portland, OR
- $50.14 - $77.83 an hour
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
RN Case Manager - Surgery Services
UCLA Health —Los Angeles, CA
- $65.53 - $84.75 an hour
- Nursing
- Surgery
- RN License
Utilization Review Coordinator
River Oaks Hospital —New Orleans, LA
- Full-time
- Background check
- Nursing
- Adults
- Health insurance
- Dental insurance
Quick Apply
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Inpatient
3d

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utilization review nurse (rn) jobs near

MDS Coordinator, RN

Confidential
Spartanburg, SC

Quick Apply

Job Details

Full-time

Benefits

Free parking
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Collaborate with healthcare professionals
Anatomy knowledge
Skilled nursing facility experience
Long-term care regulations
Medicare
Utilization review
Nursing home experience
RN License
CMS
Regulatory compliance
Coding for hospital billing
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Electronic health record (EHR) management for billing and coding
Utilization management
Resource utilization in healthcare
Health information regulatory compliance
Document review
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical documentation improvement
Health information management
Clinical confidentiality policies
Clinical documentation standards
Medical terminology

Full Job Description

Job Overview

We are seeking a dedicated and highly skilled MDS Coordinator, RN to join our dynamic healthcare team. In this vital role, you will oversee the comprehensive assessment and documentation of patient care needs within a skilled nursing or long-term care setting. Your expertise will ensure accurate completion of the Minimum Data Set (MDS), a crucial component for quality reporting, reimbursement, and care planning. You will collaborate closely with interdisciplinary teams to optimize patient outcomes, ensure compliance with regulatory standards, and support clinical documentation improvement initiatives. This position offers an exciting opportunity to impact patient care directly while utilizing your extensive nursing background and clinical knowledge.

Duties

Conduct thorough assessments of residents or patients to gather data necessary for MDS completion, ensuring accuracy and completeness in accordance with federal and state regulations.
Coordinate with interdisciplinary teams—including nursing, therapy, social work, and medical staff—to gather relevant clinical information for accurate MDS coding and documentation.
Ensure timely submission of MDS assessments in electronic health record (EHR) systems such as Epic, Cerner, or Athenahealth, maintaining compliance with Medicare and NCQA standards.
Review medical records, clinical documentation, and coding details—including CPT codes, ICD-9/ICD-10 codes, DRGs (Diagnosis-Related Groups), and other medical terminology—to support precise case management and utilization review processes.
Participate in utilization management activities such as discharge planning, hospice care coordination, and inpatient/outpatient transitions to optimize patient care pathways.
Maintain up-to-date knowledge of healthcare regulations related to Medicare reimbursement, HIPAA compliance, and quality standards for skilled nursing facilities or hospitals.
Provide education to staff on documentation best practices, coding updates, and regulatory requirements to enhance clinical documentation improvement efforts.

Requirements

Valid RN license with current state licensure; experience in nursing home settings or hospital environments preferred.
Demonstrated expertise in MDS coordination with a strong understanding of CMS guidelines and NCQA standards.
Proficiency with EMR/EHR systems such as Epic, Cerner, Athenahealth, or eClinicalWorks; experience with health information management is highly desirable.
Knowledge of medical coding including CPT procedures, ICD-9/ICD-10 diagnosis codes, DRGs, and case management principles.
Critical care experience—such as ICU or Level I/II trauma center experience—is a plus; familiarity with acute care settings enhances effectiveness.
Strong understanding of physiology, anatomy, medical terminology, and clinical documentation review processes.
Ability to navigate managed care protocols including Medicare regulations and utilization review procedures.
Excellent communication skills to collaborate effectively across multidisciplinary teams while maintaining HIPAA confidentiality standards. Join us in delivering exceptional patient care through meticulous documentation and coordinated clinical efforts! This role offers an engaging environment where your expertise directly influences patient outcomes while supporting organizational excellence in compliance and quality standards.

Benefits:

401(k)
Dental insurance
Disability insurance
Free parking
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

utilization review nurse (rn) jobs

MDS Coordinator, RN

Quality Integrator (RN) (4973) - Region 1

Clinical Review and Appeals Specialist

Registered Nurse, Care Management

Utilization Management Outpatient Authorization Nurse

Telephonic Registered Nurse Clinical Reviewer - EviCore - Remote

Utilization Management Nurse Consultant

Clinical Claims Review Nurse

Utilization Management Nurse

Medical Review Nurse- Stop Loss

Utilization Review Nurse

Utilization Review RN

Utilization Management- RN

Utilization Review Nurse (Medicare)

Utilization Review Coordinator

Nurse Case Manager, Utilization Management

Utilization Review RN

RN Case Manager - Surgery Services

Utilization Review Coordinator

RN Team Lead Utilization Review

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