Registered Nurse Utilization Review

Ascension•Austin, TX

5h•$78,562 - $110,906•Remote

About The Position

Ascension Network Services is seeking a Registered Nurse for Utilization Management to join their team. This remote position focuses on managing admissions, case management, discharge planning, and utilization review to ensure quality patient care and efficient care coordination. The role involves reviewing service requests for medical necessity and compliance, collaborating with clinical teams to resolve issues, coordinating discharge planning, and monitoring regulatory compliance. Utilization review reports and performance metrics will also be prepared as needed.

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

Utilization Review experience require

Responsibilities

Managed admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination.
Reviewed admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases.
Collaborated with clinical and administrative teams to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals.
Coordinated discharge planning with interdisciplinary healthcare teams to ensure appropriate transitions of care and continuity of services.
Monitored compliance with federal regulations and third-party payer utilization management requirements, while preparing utilization review reports and performance metrics as needed.