Registered Nurse Utilization Review
About The Position
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ 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. Evaluate medical necessity for admissions and service requests to ensure patients receive the most appropriate care at the right time. Lead the discharge planning process by collaborating with the healthcare team to create seamless transitions and safe returns home for patients. Navigate complex case management scenarios, providing expert consultation to resolve barriers to care and optimize patient outcomes. Ensure full compliance with federal and third-party regulations, protecting the integrity of our clinical services and reimbursement processes. Resolve documentation and reimbursement challenges to support the department in reducing claim denials and improving operational efficiency.
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.
Nice To Haves
- Clinical Licensure: Active and unrestricted Registered Nurse (RN) license or equivalent clinical credential required for medical necessity determination. Compact or TX state license required.
- Utilization Management Expertise: Proven experience applying medical necessity criteria (such as InterQual or Milliman) within a clinical or payer environment.
Responsibilities
- Evaluate medical necessity for admissions and service requests to ensure patients receive the most appropriate care at the right time.
- Lead the discharge planning process by collaborating with the healthcare team to create seamless transitions and safe returns home for patients.
- Navigate complex case management scenarios, providing expert consultation to resolve barriers to care and optimize patient outcomes.
- Ensure full compliance with federal and third-party regulations, protecting the integrity of our clinical services and reimbursement processes.
- Resolve documentation and reimbursement challenges to support the department in reducing claim denials and improving operational efficiency.
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
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What This Job Offers
Job Type
Part-time
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
