Top 49 Clinical documentation & utilization review nurses Jobs in Kentucky

Utilization Management Nurse Consultant
CVS Health —Kentucky
- $26.01 - $68.55 an hour
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
2d
Utilization Management Registered Nurse
Humana —Kentucky
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Quality Practice Liaison (Must be licensed in Arizona or Multi-State)
CVS Health —Kentucky
- $54,095 - $155,538 a year
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
MDS Assistant, RN
Lyndon Crossing —Saint Matthews, KY
- Nursing
- Skilled nursing facility
- RN License
- Dental insurance
- Paid time off
Quick Apply
MDS Coordinator
Eastway Health & Rehabilitation —Louisville, KY
- $40.00 - $45.86 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Disability insurance
Quick Apply
MDS Nurse Coordinator (RN) (LPN)
Morganfield Nursing and Rehab —Morganfield, KY
- Full-time
- LVN
- RN License
- Mid-level
Quick Apply
MDS
Harrison Nursing and Rehabilitation Center —Cynthiana, KY
- Full-time
- Nursing
- LVN
- RN License
Quick Apply
MDS Assistant
Clinton Place —Clinton, KY
- Full-time
- Skilled nursing facility
- Vital signs
- RN License
Quick Apply
CDI Specialist PRN
St. Elizabeth Healthcare —Erlanger, KY
- PRN
- RN License
- 5 years
- Windows
- Health insurance
- Tuition reimbursement
MDS Coordinator- PRN
Exceptional Living Centers —Lexington, KY
- PRN
- Remote
- Nursing
- RN License
- English
Quick Apply
3d
Clinical Consultant Specialist CDI
Physician Care Coordination Consultants (PC3) —Louisville, KY
- Full-time
- Nursing
- Microsoft Excel
- RN License
Clinical Documentation Analyst
Georgetown Community Hospital —Georgetown, KY
- Full-time
- Inpatient
- Mid-level
- Bachelor's degree
- Free parking
- Health insurance
Quick Apply
Documentation Specialist - LPN
Signature HealthCARE, LLC —Louisville, KY
- 12 hour shift
- CPR Certification
- Anatomy knowledge
- LVN
- Health insurance
- Dental insurance
Outcomes Analyst Full Time
Kindred Hospitals Resource Overhead —Louisville, KY
- Full-time
- Nursing
- LVN
- RN License
10d
UR COORDINATOR (RN OR MSW)
Cumberland Hall Hospital —Hopkinsville, KY
- Full-time
- Master of Social Work
- Nursing
- Psychiatry
- Health insurance
- Dental insurance
CDI Educator
Med Center Health —Bowling Green, KY
- Full-time
- Nursing
- RN License
- Mid-level
RN Clinical Appeals Manager, Medical Plaza II
UofL Health —Louisville, KY
- Full-time
- Nursing
- Microsoft Outlook
- RN License
Clinical Quality Specialist RN - Home Health
Mercy Health by Compassus —Paducah, KY
- Full-time
- Nursing
- RN License
- Mid-level
- Tuition reimbursement
Quick Apply
6d
LPN / Health Information Manager
Signature HealthCARE of North Hardin Rehab & Wellness —Radcliff, KY
- 8 hour shift
- Microsoft Word
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Regional MDS Support
Trilogy Health Services —Louisville, KY
- Full-time
- Nursing
- RN License
- Mid-level
- Health savings account
- Loan repayment program
13d

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clinical documentation & utilization review nurses jobs near kentucky

Utilization Management Nurse Consultant

CVS Health -
Kentucky

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Job Details

Full-time
$26.01 - $68.55 an hour
2 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

RN License
Associate's degree

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Fully remote with requirement to work the following schedule:

Monday-Friday 8:00am-4:30pm EST.

Position Summary

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.

The UM Nurse Consultant job duties include (not all encompassing):

Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care
Communicates with providers and other parties to facilitate care/treatment
Identifies members for referral opportunities to integrate with other products, services and/or programs
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

Must have active, current, and unrestricted RN licensure in state of residence

- Must be available to work Monday through Friday 8:00am - 4:30pm EST

Must be willing to work weekend rotation, approximately every 6 weeks
Holiday rotation per the need of the department (typically 1 holiday per year)
3+ years of clinical RN experience
1+ years of experience using Microsoft Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Preferred Qualifications

1+ years’ experience Utilization Review experience
1+ years’ experience Managed Care
Strong communication skills
Ability to manage multiple priorities, effective organizational and time management skills required
Experience in healthcare utilization management, critical care, emergency department, or case management

Education

Associate degree required

BSN preferred

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $68.55

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/28/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in kentucky

Utilization Management Nurse Consultant

Utilization Management Registered Nurse

Quality Practice Liaison (Must be licensed in Arizona or Multi-State)

MDS Assistant, RN

MDS Coordinator

MDS Nurse Coordinator (RN) (LPN)

MDS

MDS Assistant

CDI Specialist PRN

MDS Coordinator- PRN

Clinical Consultant Specialist CDI

Clinical Documentation Analyst

Documentation Specialist - LPN

Outcomes Analyst Full Time

UR COORDINATOR (RN OR MSW)

CDI Educator

RN Clinical Appeals Manager, Medical Plaza II

Clinical Quality Specialist RN - Home Health

LPN / Health Information Manager

Regional MDS Support

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