RN Utilization Review

Location: Remote

Pay

Salary range: $84,060.91 - $118,668.99 per year (Texas). Pay ranges vary based on candidate geographic location.

Benefits

• Comprehensive health coverage: medical, dental, vision, prescription coverage, and HSA/FSA options
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
• Paid time off (PTO) and holidays
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development, and online learning
• Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care, and stress management resources
• Family support: parental leave, adoption assistance, and family benefits
• Other benefits: optional legal and pet insurance, transportation savings, and more

About the role

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care, and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.

Responsibilities

• Review admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Provide case management and/or consultation for complex cases.
• Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals.
• Assess and coordinate discharge planning needs with healthcare team members.
• Prepare statistical analysis and utilization review reports as necessary.
• Oversee and coordinate compliance to federally mandated and third-party payer utilization management rules and regulations.

Requirements

• Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.
• Diploma from an accredited school/college of nursing OR required professional licensure at time of hire.