Utilization Management Registered Nurse

$1,751 per month

Ascension Seton - Austin

Details

Client Name
Ascension Seton - Austin

Job Type
Travel

Offering
Nursing

Profession
RN

Specialty
Case Manager

Job ID
35587343

Job Title
Utilization Management Registered Nurse

Weekly Pay
$1751.0

Shift Details

Shift
Day - 8x5 - 09AM

Scheduled Hours
40

Job Order Details

Start Date
11/17/2026

End Date
02/15/2027

Duration
13 Week(s)

Job Description
Job Title: RN Utilization Review
Profession: Registered Nurse
Specialty: Utilization Review
Duration: 13 Weeks
Shift: 08:30 AM - 05:00 PM
Hours per Shift: 8
Experience: Minimum of 2 years acute care utilization management experience
License: Licensed RN (multistate or TX RN)
Certifications: BLS

Must-Have:
Proficiency with InterQual/MCG and CMS regulations.
Familiarity with payer portals and managed Medicare and Medicaid insurers.
Proficient and adaptable with multiple technologies simultaneously.
Remote work experience.

Description:
Provides health care services regarding admissions, case management, discharge planning, and utilization review.
Reviews admissions and service requests for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria.
Provides case management and consultation for complex cases.
Assists departmental staff with issues related to coding, medical records, documentation, precertification, reimbursement, and claim denials or appeals.
Assesses and coordinates discharge planning needs with healthcare team members.
May prepare statistical analysis and utilization review reports as necessary.
Oversees and coordinates compliance with federally mandated and third-party payer utilization management rules and regulations.
Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
Must be able to work in a stressful environment.

Client Details

Address
1345 Philomena St

City
Austin

State
TX

Zip Code
78723

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