Top 39 Utilization review nurse Jobs in Duluth Ga

MDS Coordinator - RN
R & K Care Services LLC —Atlanta, GA
- $80,000 - $110,000 a year
- Weekends as needed
- Nursing
- Skilled nursing facility
- Microsoft Outlook
- Health insurance
- Paid time off
Quick Apply
Acute Nurse Case Manager
JenCare, A ChenMed Company —Decatur, GA
- $36.90 - $52.70 an hour
- Full-time
- Hybrid work
- Acute care
- Background check
- Nursing
- Free parking
- Health savings account
1d
Utilization Review Nurse
Oscar Health —Atlanta, GA
- $35.00 - $45.94 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Quick Apply
Registered Nurse (RN) Utilization Management - M-F (8a-4:30p) - North Fulton
3410 Wellstar North Fulton Hospital, Inc. —Roswell, GA
- Full-time
- Nursing
- RN License
- Computer literacy
20h
Manager of Clinical Annotation - Remote
UnitedHealthcare —Atlanta, GA
- $91,700 - $163,700 a year
- Full-time
- Remote
- Nursing
- RN License
- 5 years
Med Mgmt Nurse (contract)
Elevance Health —Decatur, GA
- $32.35 - $61.78 an hour
- Contract
- Hybrid work
- Nursing
- RN License
- Mid-level
- Health savings account
- Disability insurance
8d
Telephonic Case Manager I
CorVel Corporation —Lawrenceville, GA
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
11d
Utilization/Clinical Review RN -PRN
Children's Healthcare of Atlanta —Brookhaven, GA
- 8 hour shift
- Nursing
- RN License
- Computer literacy
Quick Apply
Review Nurse, Pediatric Review
Alliant Health Solutions, Inc. —Atlanta, GA
- Full-time
- Nursing
- RN License
- Computer literacy
Quick Apply
4d
Utilization Review Specialist
Positive Impact Health Centers INC —Decatur, GA
- Full-time
- LMFT
- Psychiatry
- RN License
Clinical Care Coordinator
Grady Health System —Atlanta, GA
- Full-time
- Hospital
- Mid-level
- Paid holidays
- Disability insurance
13d
Care Manager - RN
Northside Hospital Inc. —Sandy Springs, GA
- Full-time
- Nursing
- RN License
- Hospital
18h
Acute Care Nurse
Chen Medical Associates —Atlanta, GA
- $36.90 - $52.70 an hour
- Full-time
- Hybrid work
- Acute care
- Nursing
- Microsoft Outlook
- Opportunities for advancement
17h
Patient Support Nurse
Valeris, Inc. —Atlanta, GA
- Full-time
- Background check
- RN License
- Pass drug screening
- Health savings account
- AD&D insurance
Quick Apply
Medical Case Manager I
CorVel Corporation —Lawrenceville, GA
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
9d
RN MDS Nurse
Briarwood Health Center by Harborview —Tucker, GA
- Full-time
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
1d
Total Joint Coordinator RN
Resurgens Surgical Center (11505) —Atlanta, GA
- Full-time
- Nursing
- Surgery
- RN License
RN MDS Director
Perimeter Rehabilitation Suites by Harborview —Sandy Springs, GA
- Full-time
- Skilled nursing facility
- RN License
- Senior level
- Disability insurance
- Health insurance
Quick Apply
1d
Director of Clinical & Cost Containment, Employee Benefits
HUB International —Atlanta, GA
- $130,000 - $150,000 a year
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Disability insurance
- Health insurance
1d
RN Case Manager- IKC, Remote
DAVITA —Atlanta, GA
- $17.00 - $21.71 an hour
- Full-time
- Hybrid work
- Microsoft Word
- Spanish
- CPR Certification
- Health insurance
- 401(k) matching

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utilization review nurse jobs near duluth ga

MDS Coordinator - RN

R & K Care Services LLC
Atlanta, GA

Quick Apply

Job Details

Full-time
$80,000 - $110,000 a year

Benefits

Health insurance
Paid time off
Flexible schedule

Qualifications

Senior living facility experience
Computer operation
Microsoft Outlook
Resident rapport building
Patient interaction
Medical diagnostic terminology
Medical terminology

Full Job Description

Summary/Objective

In keeping with our organization’s goals, the primary purpose of the MDS coordinator is to coordinate the Resident Assessment Instrument (RAI) process including completion of an accurate/timely Minimum Data Set (MDS), developing the interdisciplinary plan of care, and leading the daily Medicare Prospective Payment System (PPS)/Medicaid Case mix Meeting.

Job Duties

Maintain current MDS status of each resident, in accordance with applicable federal and state laws, rules, and regulations as well as the facility’s policies and procedures
Schedule residents for appropriate OBRA, Medicare PPS and/or Medicaid required assessments and communicate schedule to all other departments and families, as required
Monitor clinical systems for changes in resident condition that may affect MDS process and scheduling and respond to changes in resident’s condition by coordinating MDS re-assessment and re-evaluation of plan of care
Strategically set assessment reference date (ARD), in conjunction with the interdisciplinary team, to capture needs, care and services delivered to most accurately reflect the status of the resident
Complete sections of MDS and CAAs accurately in accordance with policies, procedures, and guidelines
Coordinate and attend daily Casemix Meetings, weekly Utilization Review Meetings, and monthly Triple Check Meetings
Maintain assessments on the active clinical record for a minimum period of 15 months per Federal Regulations
Electronically transmit MDS data to the state in accordance with regulation and facility standards, policies and procedures
Have knowledge of and utilize of the facility’s written policies and procedures that govern the day-to-day functions of the nursing service department
Participate in facility surveys (inspections) made by authorized government agencies as necessary or as may be directed
Participate in developing, evaluating, revising, and implementing a plan of care for each resident to achieve and maintain the highest practicable level of wellbeing possible.
 Report any known or suspected unauthorized attempt to access facility’s information system
Provide education to residents/families/caregivers when the need arises, or as directed by Administration and/or physician
Provides prompt emergency support measures, including CPR, in accordance with physician orders, resident/family wishes, advance directives, and facility policies and procedures.
Provide complaint/grievance reports to the Administrator as required or as may be necessary
Conduct oneself in a professional manner in compliance with facility policies.
Provide care in a manner that respect for the resident's dignity and privacy is consistently upheld
Provide complaint/grievance reports to the Administrator as required or as may be necessary
Report occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals in accordance with the facility’s policies and procedures governing accidents and incidents
Report known or suspected incidents of fraud, abuse, neglect, and/or misappropriation to the Administrator
Communicate and interact effectively with residents, visitors, families, staff, and supervisors
Attend and participate in departmental meetings and in-services as directed
Report all resident, staff, or other concerns to the appropriate department head
Report all incidents, accidents, unsafe situations, and concerns immediately
Maintain knowledge of applicable federal, state, and local rules and regulations relating to responsibilities
Ensure that responsibilities are performed consistent with all applicable federal, state, and local rules and regulations as well as facility policies and procedures

Supervisory Responsibility

There are no supervisory responsibilities for this position. However, the position requires communication with and oversight of nursing home staff to ensure that specific policies, procedures, and systems are maintained correctly as it relates to the department.

Required Education and Experience

Must possess a current, unencumbered, active license to practice as a Licensed Vocational Nurse or Registered Nurse in the State
A Registered Nurse License is preferred.
2 years’ experience in Long-Term Care experience preferred.
Six (6) months experience in rehabilitative and restorative nursing practices preferred.
2 years’ experience in RAI process completion preferred.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must be able to demonstrate leadership, organizational skills, and maintain a positive and professional attitude.
Strong utilization knowledge of Point Click Care, preferred.
Computer literacy skills (Microsoft Outlook, Microsoft Office, Internet).
Ability to work well under pressure, meet deadlines and handle multiple tasks simultaneously.

Required Skills

Excellent written and verbal communication skills
Demonstrate leadership, organizational skills, and ability to maintain a positive and professional attitude
Ability to work well under pressure, meet deadlines, and handle multiple tasks simultaneously
Display attention to detail
Interact with residents, families, and the community in a professional manner
Ability to engage in active listening (giving full attention to those speaking), critical thinking (using logic and reasoning to identify strengths/weaknesses of alternative solutions), and active learning (understanding implications of new information during problem-solving situations)
Exceptional judgment and active foresight
Self-motivated and self-directed

Position Type and Expected Hours of Work

This position is within a healthcare facility that operates every day. Although this is generally a Monday through Friday position, there will be scheduled times of work on the weekends and holidays. Significant events can occur at any given time that require working. Ongoing direction and support may be necessary if systems are not properly implemented, continuously improved, and monitored.

Work Environment and Physical Demands

This position generally will require physical activity. It may at times require walking to various locations within a facility. This position routinely uses standard office equipment such as computers, phones, photocopiers and may require some use of machinery consistent with the job duties.

While performing the duties of this position, the employee is regularly required to talk and hear. This position at times requires the ability to walk, sit, use hands, reach, climb, stoop, bend, kneel, twist, and lift as necessary.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and assignments may change at any time with or without notice.

Reasonable Accommodation

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Job Type: Full-time

Pay: $80,000.00 - $110,000.00 per year

Benefits:

Flexible schedule
Health insurance
Paid time off

License/Certification:

RN Certification (Required)

Ability to Commute:

Atlanta, GA 30305 (Required)

Ability to Relocate:

Atlanta, GA 30305: Relocate before starting work (Required)

Work Location: In person

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Refine Your Search

utilization review nurse jobs in duluth ga

MDS Coordinator - RN

Acute Nurse Case Manager

Utilization Review Nurse

Registered Nurse (RN) Utilization Management - M-F (8a-4:30p) - North Fulton

Manager of Clinical Annotation - Remote

Med Mgmt Nurse (contract)

Telephonic Case Manager I

Utilization/Clinical Review RN -PRN

Review Nurse, Pediatric Review

Utilization Review Specialist

Clinical Care Coordinator

Care Manager - RN

Acute Care Nurse

Patient Support Nurse

Medical Case Manager I

RN MDS Nurse

Total Joint Coordinator RN

RN MDS Director

Director of Clinical & Cost Containment, Employee Benefits

RN Case Manager- IKC, Remote

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