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

Schedule

Days | Part Time

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.
• May 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.

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
• Time to recharge: 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