Utilization Review Nurse

Responsibilities Focus primarily on insurance authorization management, payer communication, reimbursement support, and coordination with the business office, with limited direct clinical nursing responsibilities. Coordinate between St Augustine Manor, insurance company, and resident; provide updates on resident’s health status, therapy progress, discharge planning, and changes in condition to ensure continued insurance coverage. Provide timely updates to St Augustine staff on changes to insurance coverage so appropriate planning for resident’s discharge or further stay can be implemented. Work alongside the nursing MDS department to complete assessments, maximize reimbursement, and maintain compliance for state and federal regulations, completing accurate MDS and care plans as assigned. Understand recertification documentation and communicate with managed care plans. Knowledge of NOMNC, appeal process, reconsideration, LOC and long‑term authorizations required. Attend weekly utilization review and monthly triple‑check meetings. Collaborate with admissions, therapy, social services, and business office teams. Requirements Experience with MDS, Medicare, managed care, or utilization review preferred. Valid LPN/RN license. Must be able to work Monday‑Friday 8:30 am‑5 pm. Weekend availability to check emails for after‑hour/weekend NOMNCS. Prior MDS 3.0 experience (minimum 2 years). Highly organized, professional, motivated, self‑directed, and able to manage multiple priorities. Solid computer skills. Excellent communication skills; friendly and a team worker. Experience MDS 3.0: minimum 2 years. Long‑term care: minimum 2 years. Schedule 8‑hour shift. Day shift. Benefits 401(k) with matching. Dental insurance. Disability insurance. Employee assistance program. Flexible schedule. Flexible spending account. Free parking. Health insurance. Health savings account. Life insurance. Paid time off. Tuition reimbursement. Vision insurance. Work location: in person. #J-18808-Ljbffr St. Augustine Health Ministries