Utilization Review Nurse

About the role

Remote Department: Utilization Management. Full-Time | Days.

Responsibilities

• Admissions & Medical Necessity Review: Evaluating service requests and admissions for medical necessity using evidence-based tools (like InterQual) to ensure they comply with reimbursement policies.
• Case Management & Consultation: Providing coordination and consultation for complex cases to enhance clinical outcomes and manage the cost of care.
• Administrative & Billing Support: Assisting staff with medical documentation, coding, precertification, and managing claim denials or appeals.
• Discharge Planning: Assessing and coordinating a patient's post-hospital needs, such as home health, medical equipment, or transfers to skilled nursing facilities.

Qualifications

• Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date.
• 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: pro-rated 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.

Pay

$70,699.20 - $133,078.40 per year