Top 7 utilization management nurse Jobs in dexter mo

Continuum of Care Coordinator
Poplar Bluff Regional Medical Center —Poplar Bluff, MO
- Full-time
- Remote
- Nursing
- RN License
- Primary Care
- Health insurance
- Dental insurance
Quick Apply
Case Manager - RN
Missouri Delta Medical Center —Sikeston, MO
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
Physician Assistant/Nurse Practitioner (D), CVOR - Regional
Corewell Health —United States
- Weekends as needed
- Acute care
- Nursing
- Surgery
- Free parking
- Paid holidays
Medicare Medical Review RN (Medical Reviewer III)
CoventBridge Group —United States
- $65,000 - $75,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance
5d
Registered Nurse (RN) | Work from home | $34/hr | Starts 6/29/26
Carenet Health —United States
- $34 an hour
- Weekends as needed
- Remote
- Bilingual
- Nursing
- RN License
- Continuing education credits
- Paid holidays
4d

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RN, LSW, LISW, Care Manager
Careforth —Columbus, OH
Ability and flexibility to travel (usually by car) within assigned geographic area; valid driver’s license and car insurance required.
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utilization management nurse jobs near dexter mo

Continuum of Care Coordinator

Poplar Bluff Regional Medical Center -
Poplar Bluff, MO

Quick Apply

Job Details

Full-time

Benefits

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

Qualifications

Transitional care planning in clinical case management
Utilization management
Resource utilization in healthcare
Associate's degree
Managing patients as a clinical case manager
Hospital experience

Full Job Description

This is a remote position that requires travel within Missouri and Oklahoma

Job Summary

The Continuum of Care Coordinator (CCC) oversees the continuum of care in assigned markets for the MSSP ACOs ensuring that patients receive the highest quality of care while responsibly managing Medicare resources. The CCC is responsible for managing patient transitions between hospitals, clinics, and post-acute care providers. They conduct group and individual meetings with hospital leadership and post-acute administrators promoting timely access to appropriate levels of quality care while working to reduce readmissions, avoidable hospital services, length of stay and home health recertification. The CCC builds strategic relationships in the community with the goal of enhancing patient health and well-being and reducing healthcare costs. The CCC monitors data and presents to hospital leadership to identify trends in resource utilization and serves as a local subject-matter expert (SME) on all things ACO for their supported markets.

What We Offer:

Competitive Pay
Medical, Dental, Vision, and Life Insurance
Generous Paid Time Off (PTO)
Extended Illness Bank (EIB)
Matching 401(k)
Opportunities for Career Advancement
Rewards & Recognition Programs
Exclusive Discounts and Perks*

Essential Functions

Develops, maintains, and coordinates the Post-Acute Care Collaborative for assigned markets, serving as the primary liaison between collaborative partners and hospital leadership to ensure continuity of care. Updates the Collaborative based on ACO Scorecard data and CMS performance metrics.
Tracks discharge patterns for Medicare patients, collaborating with hospital and post-acute care teams to support ACO benchmarks through education, data sharing, and planning efforts.
Monitors metrics, identifies trends, and utilizes data to support improvement in care quality for ACO patients. Recommends actionable steps to hospital leadership to help the market meet CMS benchmarks and reduce avoidable costs.
Collects and communicates information on successes and barriers to the Payment Innovations team, supporting the development and evaluation of strategic plans for ACO performance improvement.
Maintains current knowledge of ACOs and value-based care programs impacting Medicare patients, providing expertise to assist with reimbursement strategies and alignment with CMS benchmarks.
Prepares and shares ACO scorecard data with primary care provider groups and facilitates discussions with providers and practice leaders in coordination with the PPS Quality team.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.

Qualifications

Associate Degree in Nursing or Healthcare Management required
Bachelor's Degree in Healthcare Administration or related field preferred
2-4 years of strong clinical or healthcare experience with a focus on hospital discharge planning, utilization management, and case management required
Previous experience as a Care Navigator for high-risk patient populations preferred

Knowledge, Skills and Abilities

Demonstrates strong knowledge of pre-acute and post-acute care resources, care transitions, and healthcare utilization management.
Proficient in data aggregation and analysis, with the ability to present ACO performance metrics effectively.
Strong interpersonal and communication skills to collaborate with multidisciplinary teams and external stakeholders.
Advanced proficiency in Google Suite and Microsoft Excel for reporting and data management.
Possess a high level of organizational and problem-solving skills to manage multiple priorities in a dynamic environment.
Demonstrates attention to detail and the ability to interpret and apply CMS benchmarks and regulations.

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred

Quick Apply

Refine Your Search

utilization management nurse jobs in dexter mo

Continuum of Care Coordinator

Case Manager - RN

Physician Assistant/Nurse Practitioner (D), CVOR - Regional

Medicare Medical Review RN (Medical Reviewer III)

Registered Nurse (RN) | Work from home | $34/hr | Starts 6/29/26

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