Utilization Review Nurse

Utilization Review Specialist Cleveland, OH (on-site) $40-43/HR 8:30 am-5 pm (M-F) The UR Specialist plays a critical role in coordinating resident assessments, care planning, utilization review, reimbursement, and interdisciplinary communication to ensure high-quality, cost-effective resident care while maintaining compliance with state and federal regulations. UR Specialist Responsibilities: Coordinate and oversee completion of MDS 3.0 assessments and comprehensive resident care plans. Complete assessments for newly admitted residents and residents experiencing significant changes in condition. Review interdisciplinary documentation to ensure accurate and complete resident assessments. Maintain compliance with CMS, Medicare, Medicaid, State of Ohio, and federal documentation requirements. Attend utilization review meetings and collaborate with interdisciplinary teams regarding resident eligibility and insurance coverage. Monitor Medicare and managed care benefits, including tracking Medicare benefit days. Promote resident rights, dignity, privacy, and confidentiality. UR Specialist Qualifications: Current, valid, and unrestricted LPN or RN license in OH is preferred but not required. Previous MDS coordination and utilization review experience in a skilled nursing or long-term care setting. Experience with managed care authorization processes. Strong clinical assessment skills. Flexibility to work occasional evenings, weekends, or additional hours as needed. Knowledge of: Medicare Medicaid PPS reimbursement Subacute/skilled nursing care