Utilization Review Nurse
Ascension•Belle Meade, TN
•$34 - $64•Remote
About The Position
This role focuses on evaluating service requests and admissions for medical necessity, providing case management and consultation, assisting with administrative and billing tasks, and coordinating post-hospital care. The goal is to ensure compliance with reimbursement policies, enhance clinical outcomes, manage costs, and support patients in their transition to post-hospital care.
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 required.
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
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.
Benefits
- Paid time off (PTO)
- Various health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
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What This Job Offers
Career Level
Mid Level
Education Level
Associate degree
