Cleveland, Ohio, 44102
Job description
Utilization Review Nurse
Cleveland, OH (on-site)
$40-47/HR
8:30 am-5 pm (M-F)
The role of the **UR Nurse** is vital in managing resident evaluations, developing care plans, conducting utilization reviews, overseeing reimbursement processes, and facilitating communication among various disciplines to guarantee that residents receive high-quality, economical care in compliance with state and federal regulations.
Responsibilities of the UR Nurse:
- Oversee the timely completion of MDS 3.0 assessments and detailed resident care plans.
- Conduct evaluations for new admissions and for residents whose conditions have notably changed.
- Examine interdisciplinary documentation to ensure all resident assessments are thorough and accurate.
- Ensure adherence to the documentation standards set forth by CMS, Medicare, Medicaid, the State of Ohio, and federal regulations.
- Participate in utilization review meetings and work closely with interdisciplinary teams on resident eligibility and insurance matters.
- Track Medicare and managed care benefits, monitoring Medicare benefit days as necessary.
- Uphold the rights, dignity, privacy, and confidentiality of all residents.
Qualifications for the UR Nurse:
- Possession of a current, valid, and unrestricted LPN or RN license in Ohio.
- Proficient clinical assessment abilities.
- Willingness to occasionally work evenings, weekends, or beyond standard hours as required.
- Familiarity with:
- Medicare
- Medicaid
- PPS reimbursement
- Subacute and skilled nursing care
Preferred Qualifications for the UR Nurse:
- Experience in MDS coordination and utilization review within a skilled nursing or long-term care environment.
- Knowledge of managed care authorization processes.
STEMHUNTER is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity, and gender expression), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. We comply with all applicable equal employment opportunity and affirmative action regulations.
