RN Utilization Review PRN

Ascension•Remote,

1d•$40 - $57•Remote

About The Position

Ascension Care Management Insurance is seeking an RN Utilization Review professional to join their Utilization Review department. This remote, day shift, PRN position offers a salary range of $40.41-$57.05 per hour. The role involves conducting comprehensive clinical reviews, navigating complex cases, supporting operational and denial management, and coordinating discharge planning.

Requirements

Registered Nurse obtained prior to hire date or job transfer date required.
Licensure required relevant to state in which work is performed.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Health plan or inpatient utilization experience.
InterQual or MCG experience.

Nice To Haves

Health plan or inpatient utilization experience preferred
InterQual or MCG experience preferred
Minimum of 3 years nursing experience preferred
Nursing Licensure Compact (NLC) strongly preferred

Responsibilities

Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.
Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.
Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.
Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.