Registered Nurse Utilization Review

Ascension•Jenks, OK

15h•Remote

About The Position

Ascension St. John Medical Center is seeking a Registered Nurse for Utilization Review to join their team. This remote position is responsible for securing patient-centered care by validating medical necessity, advocating for benefits, and coordinating transitions to reduce readmissions. The role also focuses on maximizing financial health by preventing claim denials and managing appeals, driving operational efficiency by coordinating with multidisciplinary teams, and upholding quality and compliance by enforcing clinical standards and payer regulations.

Requirements

Registered Nurse credentialed from the Oklahoma Board of Nursing 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

5+ years of Nursing experience
Case Management or Utilization Management experience preferred

Responsibilities

Secures patient-centered care by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
Maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.