Utilization Review RN
About The Position
Your future role at a glance Location: Remote Facility: Ascension St Thomas Department: Case Management Schedule: Part Time 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 99,000+ 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: 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 Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process. How you’ll make an impact in this role Provide health care services regarding admissions, case management, discharge planning and utilization review. Review 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 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.
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.
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Responsibilities
- Provide health care services regarding admissions, case management, discharge planning and utilization review.
- Review 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.
Benefits
- 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: 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
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Associate degree
