Registered Nurse - Utilization Review

Details

Client Name
Ascension Seton - Texas Administrative Offices

Job Type
Travel

Offering
Nursing

Profession
Registered Nurse

Specialty
Utilization Review

Job ID
38515471

Job Title
Registered Nurse - Utilization Review

Weekly Pay
$1766.5


Shift Details

Shift
7:00 AM - 3:00 PM

Scheduled Hours
40


Job Order Details

Start Date
11/10/2026

End Date
02/08/2027

Duration
13 Week(s)


Job Description
Exciting Opportunity for a Utilization Management Registered Nurse!

Job Description:
- Join a dynamic Utilization Management Department operating fully remote
- Provide exceptional health care services focused on:
- Admissions
- Case management
- Discharge planning
- Utilization review
- Review admissions and service requests, ensuring compliance with medical necessity and reimbursement policy criteria
- Deliver case management and consultation for complex cases
- Assist team members with issues related to:
- Coding
- Medical records/documentation
- Precertification
- Reimbursement and claim denials/appeals
- Assess and coordinate discharge planning needs with healthcare team members
- Prepare statistical analysis and utilization review reports as needed
- Ensure compliance with federally mandated and third-party payer utilization management rules and regulations
- Work with minimal supervision, exercising critical thinking and decisive judgment in a fast-paced environment

Complexity of Work:
- Requires strong critical thinking skills
- Ability to work effectively under stress

Unit Description:
- Centralized Utilization Management department supporting 13 acute care and critical access hospitals
- Utilization Management focus

Required Skills/Experience:
- Licensed RN (multistate or TX RN)
- Minimum of 2 years acute care UM experience (or equivalent)
- Proficient in InterQual/MCG and CMS regulations

Preferred Skills/Experience:
- Familiarity with payor portals
- Knowledge of managed Medicare and Medicaid insurers
- Experience with Google Workspace
- Previous remote work experience

Credentials:
- Professional licenses and background checks required
- Health screenings and immunizations mandated

Why BHS Workforce (BHS):
At BHS, we connect dedicated nurses and allied health clinicians with the best assignments across the country. Enjoy competitive pay, seamless onboarding, and a supportive recruiter who's with you every step of the way. Join us and see how our clinicians come first. We put our heart and money where our mouth is and promise you will not be disappointed!


Client Details

Address
1345 Philomena St, Austin

City
Austin

State
TX

Zip Code
78723


Job Board Disclaimer

Compensation rates, benefits, and assignment details are subject to change and may vary based on factors including, but not limited to, experience, location, client requirements, and compliance with applicable laws and regulations. Final employment terms are confirmed at the time of offer and onboarding.