Top 35 Utilization review nurse Jobs in Clearwater, Fl

MDS Coordinator RN or LPN
the oaks of clearwater —Clearwater, FL
- From $70,000 an hour
- Full-time
- RN License
- Medical office experience
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
9d
Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida
Molina Healthcare —Tampa, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Physical Therapy License
- Health insurance
Care Review Clinician (RN) - Remote in FL
Molina Healthcare —Saint Petersburg, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare —Saint Petersburg, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
Medicare Advantage Appeals RN
BayCare —Clearwater, FL
- Weekends as needed
- Nursing
- RN License
- Mid-level
Healthcare Svcs Review Nurse
Hillsborough County, Florida —Tampa, FL
- $32.84 - $60.18 an hour
- Background check
- Spanish
- RN License
2d
Case Manager, RN- Utilization Review
Tampa General Hospital —Tampa, FL
- $36.41 an hour
- 8 hour shift
- Hybrid work
- Microsoft Word
- Nursing
- Microsoft Excel
7d
Clinical Nurse Reviewer
Zelis —Saint Petersburg, FL
- $59,000 - $75,050 a year
- Full-time
- Nursing
- RN License
- Inventory management
- Paid holidays
- Disability insurance
Utilization Review Specialist Senior
BayCare —Tampa, FL
- Weekends as needed
- Hybrid work
- Nursing
- RN License
- Hospital
- Tuition reimbursement
- 401(k) matching
Nurse Case Manager
Battelle —Tampa, FL
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
Clinical Navigator
Paradigm Corp —Tampa, FL
- $73,000 - $88,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Customer service
- Health savings account
- Paid holidays
4d
RN Case Manager PRN Days
Moffitt Cancer Center —Tampa, FL
- $44.25 an hour
- Weekends as needed
- Nursing
- RN License
- BLS Certification
9d
Utilization Reviewer 2
Enlyte —Tampa, FL
- $59,500 - $76,000 a year
- Full-time
- RN License
- Mid-level
- Office
- Health savings account
- AD&D insurance
RN Care Manager - FGC Market
ArchWell Health —Dunedin, FL
- Full-time
- Nursing
- RN License
- Mid-level
2d
(Part-Time) Legal Nurse Case Reviewer | Orthopaedics / Neurosurgery | Onsite
Shimspine —Oldsmar, FL
- Part-time
- Nursing
- RN License
- 5 years
- Paid training
- Flexible schedule
Quick Apply
11d
Care Manager
AaNeel Infotech —Tampa, FL
- Full-time
- Spanish
- English
- Mid-level
- Health insurance
- Dental insurance
APRN(Largo)
Clean Recovery Centers —Largo, FL
- $110,000 - $125,000 a year
- Full-time
- Psychiatry
- Addiction Medicine
- Mid-level
Quick Apply
19h
PMHNP-Bradenton/Sarasota
Clean Recovery Centers —Tampa, FL
- $65 - $75 an hour
- Part-time
- Addiction Medicine
- Mid-level
- Rehabilitation center
Quick Apply
LPN Charge Nurse/MDS Coordinator
OAKS ON THE BAY LLC —Clearwater, FL
- RN License
- Medical office experience
- HIPAA
Quick Apply
MDS Resource
Everglades Healthcare —Tampa, FL
- $86,000 - $91,000 a year
- Weekends as needed
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply

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utilization review nurse jobs near clearwater, fl

MDS Coordinator RN or LPN

the oaks of clearwater
Clearwater, FL

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Job Details

Full-time
From $70,000 an hour
9 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
Life insurance

Qualifications

Medical office experience
HIPAA
Organizational skills
Health information management
Medical terminology

Full Job Description

We are seeking a highly skilled and detail-oriented MDS Coordinator (Must have active FL RN or LPN Nursing License) to join our healthcare team. The ideal candidate will possess comprehensive knowledge of the Minimum Data Set (MDS)/PDPM process, clinical documentation, and regulatory compliance standards. As an essential member of our interdisciplinary team, the MDS Coordinator will oversee the accurate collection, review, and submission of resident data to ensure optimal reimbursement, quality reporting, and compliance with federal and state regulations. This role offers an opportunity to contribute significantly to patient care quality and operational efficiency within a dynamic healthcare environment.

Responsibilities

Coordinate the comprehensive assessment and documentation of resident conditions in accordance with MDS guidelines, ensuring accuracy and completeness.
Collaborate with nursing staff, physicians, case managers, and other healthcare professionals to gather pertinent clinical information for MDS completion.
Review medical records, clinical documentation, and coding details—including ICD-10 codes—to support precise data entry and compliance with SNF Medicare and other payer requirements.
Ensure timely submission of MDS assessments in alignment with regulatory deadlines while maintaining adherence to state-specific regulations.
Utilize EMR (Electronic Medical Record) systems such as Point Click Care or similar to document assessments within the electronic health record (EHR)
Conduct ongoing education for staff on documentation improvement strategies, utilization management, and coding updates related to ICD coding systems.
Monitor quality metrics related to clinical documentation improvement (CDI), discharge planning, hospice care, and case management processes to optimize patient care outcomes.
Maintain strict compliance with HIPAA regulations while managing sensitive medical records and ensuring confidentiality throughout all documentation processes.

Qualifications

Proven experience in managed care settings or hospital environments with a strong understanding of inpatient and outpatient clinical workflows.
Extensive knowledge of Point Click Care or similar EMR Systems
Familiarity with ICD-10 coding standards, DRG assignment, and utilization review processes.
Background in medical office administration or health information management with a focus on medical documentation review.
Strong understanding of SNF Medicare regulations, discharge planning procedures, and hospice care protocols.
Excellent organizational skills coupled with the ability to interpret complex medical terminology and physiology knowledge for accurate data collection.

Pay: From $70,000.00 per hour

Benefits:

Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

utilization review nurse jobs in clearwater, fl

MDS Coordinator RN or LPN

Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (BH Licensed) - Remote in FL

Medicare Advantage Appeals RN

Healthcare Svcs Review Nurse

Case Manager, RN- Utilization Review

Clinical Nurse Reviewer

Utilization Review Specialist Senior

Nurse Case Manager

Clinical Navigator

RN Case Manager PRN Days

Utilization Reviewer 2

RN Care Manager - FGC Market

(Part-Time) Legal Nurse Case Reviewer | Orthopaedics / Neurosurgery | Onsite

Care Manager

APRN(Largo)

PMHNP-Bradenton/Sarasota

LPN Charge Nurse/MDS Coordinator

MDS Resource

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