RN - Utilization Review

Your Future Role At A GlanceLocation: RemoteFacility: Ascension Network ServicesDepartment: Utilization ManagementSchedule: Days l Part TimeSalary range: $84,060.91 - $118,668.99 per year (Texas) | Pay ranges vary based on candidate geographic locationLife At Ascension: Where Purpose Meets OpportunityAscension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.Benefits That Help You ThriveComprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA optionsFinancial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insuranceTime to recharge: pro-rated paid time off (PTO) and holidaysCareer growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learningEmotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resourcesFamily support: parental leave, adoption assistance and family benefitsOther benefits: optional legal and pet insurance, transportation savings and moreHow You'll Make An Impact In This RoleReview admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.Assess and coordinate discharge planning needs with healthcare team members.May prepare statistical analysis and utilization review reports as necessary.Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.What Minimum Requirements You'll NeedLicensure / Certification / Registration: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.Education:Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.Equal employment opportunity employerAscension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws.Fraud prevention noticeProspective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.E-Verify statementEmployer does not participate in E-Verify and therefore cannot employ STEM OPT candidates.