Utilization Review Nurse

Ascension•Murfreesboro, TN

6h•$70,699 - $133,078•Remote

About The Position

This role is responsible for evaluating service requests and admissions for medical necessity using evidence-based tools to ensure compliance with reimbursement policies. The Utilization Review Nurse will also provide coordination and consultation for complex cases to enhance clinical outcomes and manage the cost of care. Additionally, this role will assist staff with medical documentation, coding, precertification, and managing claim denials or appeals. A key responsibility includes assessing and coordinating a patient's post-hospital needs.

Requirements

Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Nice To Haves

Experience with InterQual

Responsibilities

Evaluating service requests and admissions for medical necessity using evidence-based tools (like InterQual) to ensure they comply with reimbursement policies.
Providing coordination and consultation for complex cases to enhance clinical outcomes and manage the cost of care.
Assisting staff with medical documentation, coding, precertification, and managing claim denials or appeals.
Assessing and coordinating a patient's post-hospital needs, such as home health, medical equipment, or transfers to skilled nursing facilities.