Your future role at a glanceLocation: Remote
Facility: Ascension Network Service
Department: Utilization Management
Schedule: Days l Full Time
Salary range: $84,060.91 - $118,668.99per year (Texas) | Pay ranges vary based on candidate geographic location
How you'll make an impact in this roleProvide 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 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.
ResponsibilitiesProvide 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.
QualificationsLicensure / 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.
