RN Utilization Review PRN

Your future role at a glance Location: Remote Facility: Ascension Care Management Insurance Department: Utilization Review Schedule: Day Shift | PRN Salary: $40.41-$57.05 (per hour) Life at Ascension: Where purpose meets opportunity 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. Benefits that help you thrive Retirement: 403(b) planWell-being support: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources How you’ll make an impact in this role Comprehensive Clinical Review: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.Complex Case Navigation: Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.Operational & Denial Support: Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.Strategic Discharge Coordination: Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.Health plan or inpatient utilization experience and InterQual or MCG experience. What Minimum Requirements You’ll Need Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to state in which work is performed. Education Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. What Additional Preferences We're Seeking Health plan or inpatient utilization experience preferredInterQual or MCG experience preferredMinimum of 3 years nursing experience preferredNursing Licensure Compact (NLC) strongly preferred Equal employment opportunity employer Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster. Fraud prevention notice Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system. E-Verify statement Employer participates in the Electronic Employment Verification Program. Please click here for more information.