ZipRecruiter

Log In

1

Sco Um Review Rn Jobs (NOW HIRING)

A24Group

Travel RN Utilization Management (RN UM)

Camden, ME · On-site

$5.3K - $6.2K/wk

This position blends clinical review and coordination with on‑unit presence, ensuring residents ... Class: RN UM * Guarantee: 40 hours/week * Rate: $53,40-$62,30 per hour * Location: Windward Gardens ...

Dignity Health Medical Foundation

$53.46 - $79.52/hr

Ensures UM Physicians are provided the relevant information needed to accurately review a referral ... Clear and current CA Registered Nurse (RN) license * Ability to demonstrate leadership and ...

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.8K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

next page

Showing results 1-20

All JobsSco Um Review Rn Jobs

Sco Um Review Rn information

See salary details

$20

$44

$73

How much do sco um review rn jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for sco um review rn in the United States is $44.48, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $51.92 per hour, depending on experience, location, and employer.

What are some common challenges faced by a SCO UM Review RN and how can they be managed effectively?

A SCO UM Review RN often faces challenges such as balancing a high volume of case reviews with the need for thorough, accurate assessments and staying updated with frequently changing regulatory requirements. Time management and strong organizational skills are crucial for managing daily responsibilities, which typically include reviewing medical records, collaborating with interdisciplinary teams, and communicating with providers and members. Building strong relationships with both clinical and non-clinical staff can help streamline workflows, while ongoing professional development ensures you remain current with best practices and compliance standards.

What does an UM review nurse do?

An UM review nurse evaluates medical necessity and appropriateness of healthcare services for insurance or healthcare organizations. They review patient records, collaborate with healthcare providers, and ensure compliance with policies, often using clinical guidelines and documentation to make informed decisions.

What are the key skills and qualifications needed to thrive as a SCO UM Review RN, and why are they important?

To thrive as a SCO UM Review RN (Senior Care Options Utilization Management Review Registered Nurse), you need a valid RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria for managed care populations. Familiarity with utilization management software, InterQual or Milliman guidelines, and electronic health records is typically required. Exceptional attention to detail, critical thinking, and effective communication are vital soft skills for collaborating with care teams and advocating for patient needs. These skills ensure accurate review processes, regulatory compliance, and optimized patient outcomes in managed care environments.

What are SCO UM Review RNs?

SCO UM Review RNs are registered nurses who specialize in Utilization Management (UM) review for Senior Care Options (SCO) programs. They evaluate medical records, treatment plans, and healthcare services to ensure that care provided to elderly patients is medically necessary and meets health plan guidelines. These nurses play a key role in coordinating care, preventing unnecessary services, and advocating for appropriate patient care within managed care organizations.

What is the difference between Sco Um Review Rn vs Licensed Practical Nurse?

AspectSco Um Review RnLicensed Practical Nurse
CredentialsRegistered Nurse (RN) license, possibly specialized certificationsLicensed Practical Nurse (LPN) license
Work EnvironmentHospitals, clinics, outpatient facilities, often in more complex care settingsLong-term care, nursing homes, clinics, with more routine patient care
Job ResponsibilitiesAssessments, care planning, complex patient care, medication administrationBasic patient care, vital signs, assisting RNs and physicians

Both Sco Um Review Rn and Licensed Practical Nurse roles involve patient care, but Sco Um Review Rn typically requires a higher level of education and certification, allowing for more complex responsibilities. LPNs focus on routine patient care and support roles. The choice depends on your career goals and desired scope of practice.

How much does Cigna pay remote nurses?

Cigna offers remote nursing positions, and pay rates typically range from $30 to $50 per hour depending on experience, location, and specific role. Compensation may also include benefits such as health insurance and retirement plans, and remote nurses often need relevant licensure and clinical experience.

How to make an extra $2000 a month as a nurse?

A nurse can increase income by taking on overtime shifts, working in high-demand specialties, or providing private care services. Developing specialized skills or certifications, such as in anesthesia or critical care, can also qualify for higher-paying roles or side gigs outside regular hours.

How to make $300,000 as a nurse?

To earn $300,000 as a nurse, professionals often work in high-paying specialties such as nurse anesthetist or nurse practitioner, which require advanced certifications and education. Increasing hours, taking on overtime, or working in high-demand areas can also boost income, along with gaining experience and specialized skills. Some nurses pursue travel nursing or administrative roles to increase earning potential.
More about Sco Um Review Rn jobs
What states have the most Sco Um Review Rn jobs? States with the most job openings for Sco Um Review Rn jobs include:
What job categories do people searching Sco Um Review Rn jobs look for? The top searched job categories for Sco Um Review Rn jobs are:
Sco Um Review Rn jobs near you
Infographic showing various Sco Um Review Rn job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $92,525 per year, or $44.5 per hour.
Clinical Documentation Review RN

Clinical Documentation Review RN

Fallon Health

Worcester, MA • On-site

Other

Posted 17 days ago

Fallon Health rating

7.3

Company rating: 7.3 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

Overview
About us:
Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose:
The Clinical Documentation Review RN is responsible for auditing care plans, health risk assessments, MDS assessments and other clinical documentation to ensure accuracy, completeness, and compliance. This role supports quality of care and regulatory adherence by reviewing documentation against CMS and state contractual guidelines. The reviewer provides feedback and guidance to clinical teams to promote accurate, consistent and compliant documentation that reflects the member's health status and care needs.
Responsibilities
Primary Job Responsibilities:
  • Audits documentation ensuring documentation meets quality standards and interventions and actions are effective to meet member needs
  • Conduct audits of medical records to verify that documentation supports the services provided, meets regulatory standards, and aligns with SCO program requirements.
  • Ensure interdisciplinary care plans are updated and reflect current member needs and are in compliance with regulatory and accreditation requirements.
  • Confirm that assessments are documented and integrated into care planning.
  • Audit MDS-HC forms entered into the State's System to ensure compliance with current Supplemental Instructions
  • Audit documentation for evidence of care coordination across medical, behavioral health, and long-term services.
  • Ensure transitions of care (e.g., hospital discharge) are documented with follow-up plans and communication between providers.
  • Identify documentation gaps that may impact care coordination, reimbursement, or compliance with MassHealth, CMS, and SCO-specific guidelines.
  • Collaborate with providers and care teams to clarify clinical documentation through queries and feedback, ensuring accurate reflection of patient acuity, diagnoses, and care plans.
  • Monitor trends and patterns in documentation errors or omissions and recommend corrective actions or process improvements.
  • Educate clinical staff on best practices for documentation, including SCO-specific standards, regulatory updates, and audit findings.
  • Participate in interdisciplinary and team meetings to provide insight into documentation quality and contribute to care planning and compliance strategies.
  • Maintain audit logs and reports to track findings, follow-up actions, and performance metrics related to documentation quality and integrity.
  • Collaborate with departments throughout Fallon to ensure documentation aligns with company policies and procedures.

Qualifications
Education:
Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred
License/Certifications:
License: Active, unrestricted license as a Registered Nurse in Massachusetts
Certification: Certification in Case Management preferred
Other: Satisfactory Criminal Offender Record Information (CORI) results, reliable transportation
Experience:
4+ years job experience as a Registered Nurse working in a care management/care coordination role in a managed care payor operating a dual Special Needs Plan required.
Experience with NCQA, CMS, and other required regulatory requirements and experience writing and developing policies and process documents required.
Experience with developing audit tools, auditing team member performance, and working with staff to improve their performance preferred.
Demonstrated proficiency including but not limited to:
  • Ability to develop a system and process to objectively measure care management competencies and to hold team members accountable, including, but not limited to developing corrective action plans, as appropriate
  • Ability to identify gaps in staff's knowledge base and to design training materials to address those gaps
  • Ability to teach others in an organized and structured manner utilizing adult learning principles and collaboration skills
  • Advanced skills in software systems including but not limited to Microsoft Office Products - Excel, Outlook, and Word
  • Manipulation of Excel spreadsheets to manage work and exposure and familiarity with pivot tables desirable
  • Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties
  • Knowledgeable about medical record documentation
  • Critical thinking skills for independent problem solving
  • Prior experience with clinical documentation review, quality audits, or utilization review preferred.
  • Familiarity with chronic disease management, care planning and transitions of care.
  • Experience with Minimum Data Set- Home Care assessments and requirements associated with such.
  • Access and ability to navigate the State's Virtual Gateway platform for MDS-HC review and submission
  • Excellent attention to detail, analytical skills, and ability to identify discrepancies in documentation.
  • Proficiency with EMR systems and audit tools.
  • Strong written and verbal communication skills; ability to provide constructive feedback to clinical staff.
  • Strong knowledge and understanding of current State Supplemental Instructions for MDS-HC submission for rating category assignment

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $110,000 - $115,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

What Fallon Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply