Top 23 Utilization review nurse Jobs in Cleveland Oh

Utilization Review Nurse
St. Augustine Health Ministries —Cleveland, OH
- $31 - $47 an hour
- 8 hour shift
- RN License
- Computer literacy
- Computer skills
- Free parking
- Health savings account
Hospital Case Manager
Cleveland Clinic Rehabilitation Hospital - Fairhill —Cleveland, OH
- $40 an hour
- Hospital
- Inpatient
- Mid-level
- Opportunities for advancement
Quick Apply
11d
Case Manager ( RN / RT / SW / LPN )
Regency Hospital - Cleveland East —Warrensville Heights, OH
- Full-time
- RN License
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
14d
RN UTILIZATION SPECIALIST - DENIALS & APPEALS
Southwest General —Middleburg Heights, OH
- Full-time
- Nursing
- RN License
- Mid-level
MDS Nurse- RN/LPN
Certus Healthcare- Candlewood —Cleveland, OH
- $82,000 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
4d
UTILIZATION SPECIALIST-E.D.
Southwest General —Middleburg Heights, OH
- Full-time
- Nursing
- RN License
- 5 years
Case Manager (CDCA)
Women of Hope Cleveland —Solon, OH
- $24.48 - $29.48 an hour
- Part-time
- CPR Certification
- Addiction Medicine
- Experience working with individuals with disabilities
Quick Apply
RN Transitional Care Coordinator-Parma Medical Center
University Hospitals —Parma, OH
- $68,994 - $107,890 a year
- Nursing
- RN License
- Hospital
11d
Care Coordinator - Radiology
METROHEALTH MEDICAL CENTER —Cleveland, OH
- Full-time
- Nursing
- RN License
- Hospital
11h
Supervisor, Clinical Operations
Medical Mutual of Ohio —Cleveland, OH
- Hybrid work
- Nursing
- 7 years
- RN License
- Health savings account
- Disability insurance
11d
RN Care Manager - Cleveland Market
ArchWell Health —Cleveland, OH
- Full-time
- Nursing
- RN License
- Mid-level
RN
Signature Health Inc —Willoughby, OH
- Extended hours
- Spanish
- Nursing
- Vital signs
- Health insurance
- Dental insurance
RN Case Manager
Cleveland Clinic —Cleveland, OH
- $45 an hour
- PRN
- Nursing
- RN License
- Bachelor of Science
- Dental insurance
- Vision insurance
4h
MDS Nurse
Franciscan Ministries —Parma, OH
- $65,000 - $73,000 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Health savings account
- Disability insurance
5d
RN Case Manager - Neuro Expansion
Cleveland Clinic —Cleveland, OH
- $69,600.00 - $106,132.50 a year
- Full-time
- Acute care
- Nursing
- Surgery
- Dental insurance
- Vision insurance
LPN
Signature Health Inc —Lakewood, OH
- Extended hours
- Nursing
- Vital signs
- Psychiatry
- Health insurance
- Dental insurance
Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
Quick Apply

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Patient Support Nurse
Valeris, Inc. —Columbus, OH
Must have active RN licensure in current state of practice. 2-3 years of nursing experience with relevant disease state experience preferred.
Quick Apply
3d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
5d

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utilization review nurse jobs near cleveland oh

Utilization Review Nurse

St. Augustine Health Ministries -
Cleveland, OH

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Job Details

$31 - $47 an hour

Benefits

Free parking
Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Flexible schedule
Life insurance

Qualifications

Appeals
Computer operation
Overseeing health insurance pre-certification
MDS
Long-term care facility experience
Case appeal in utilization management
Computer skills
Insurance claims appeal handling

Full Job Description

Pay: $31.00 – $47.00 per hour

Job description:

SIGN ON BONUS- $10,000

Duties and responsibilities included:

This position focuses primarily on insurance authorization management, payer communication, reimbursement support and coordination with the business office with limited direct clinical nursing responsibilities.
Coordinates between St Augustine Manor, insurance company, and Resident. Provides updates to insurance company on a Resident’s health status, therapy progress, discharge planning, changes in condition, etc to help ensure continued insurance coverage to meet our Resident’s needs.
Timely updates to St Augustine staff on changes to insurance coverage so appropriate planning for Resident’s discharge or further stay can be implemented such as insurance authorizations, updates, and denials.
Works alongside the nursing MDS department to complete assessments, maximize reimbursement, and maintain compliance for state & federal regulations, completing accurate MDS & care plans as assigned.
Understand recertification documentation and communication with managed care plans.
Knowledge of NOMNC, appeal process, reconsideration, LOC and long-term authorizations required.
Attends meetings: weekly utilization review and monthly triple check.
Collaborating with admissions, therapy, social services, and business office teams.

Requirements:

Experience with MDS, Medicare, managed care or utilization review preferred.
Must be able to work Monday-Friday 8:30am-5pm.
Weekend availability to check emails for after hour/weekend NOMNCS.
Ability to work independently and manage multiple priorities.
Valid LPN/RN license.
Must have prior MDS 3.0 experience.
Must be highly organized, professional, and motivated.
Must have solid computer skills.
Excellent communication skills.
Should be friendly and a team worker

Experience:

MDS 3.0- 2 years required
Long term care- 2 years required
Schedule:

8-hour shift
Day shift

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Employee assistance program
Flexible schedule
Flexible spending account
Free parking
Health insurance
Health savings account
Life insurance
Paid time off
Tuition reimbursement
Vision insurance
Work Location: In person

Apply Now

Refine Your Search

utilization review nurse jobs in cleveland oh

Utilization Review Nurse

Hospital Case Manager

Case Manager ( RN / RT / SW / LPN )

RN UTILIZATION SPECIALIST - DENIALS & APPEALS

MDS Nurse- RN/LPN

UTILIZATION SPECIALIST-E.D.

Case Manager (CDCA)

RN Transitional Care Coordinator-Parma Medical Center

Care Coordinator - Radiology

Supervisor, Clinical Operations

RN Care Manager - Cleveland Market

RN

RN Case Manager

MDS Nurse

RN Case Manager - Neuro Expansion

LPN

Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

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