Registered Nurse Utilization Review

Ascension•Austin, TX

3h•$84,061 - $118,669•Remote

About The Position

This role focuses on managing admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination. The Registered Nurse will review admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases. Collaboration with clinical and administrative teams is essential to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals. Coordination of discharge planning with interdisciplinary healthcare teams ensures appropriate transitions of care and continuity of services. The role also involves monitoring compliance with federal regulations and third-party payer utilization management requirements, and preparing utilization review reports and performance metrics.

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.
Utilization Review experience

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.