Utilization Review Nurse

Your future role at a glance

Location: Ascension Saint Thoma

Facility: Remote

Department: Utilization Management

Schedule: Full-Time | Day

Salary Range: $70,699.20 - $133,078.40 per year

Life at Ascension: Where purpose meets opportunity

Ascension 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 thrive

• Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
• Time to recharge: pro-rated paid time off (PTO) and holidays
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
• Emotional well-being: Employee Assistance Program , counseling and peer support, spiritual care and stress management resources
• Family support: parental leave, adoption assistance and family benefits
• Other benefits: optional legal and pet insurance, transportation savings and more

How you'll make an impact in this role

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

What minimum requirements you'll need

Licensure / Certification / Registration:

Required Credential(s):

• 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.

Education:

• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Equal employment opportunity employer


Ascension 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. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice


Prospective 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 statement


Employer participates in the Electronic Employment Verification Program. Please click here for more information.

Responsibilities

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

Qualifications

Licensure / Certification / Registration:

Required Credential(s):

• 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.

Education:

• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.