Your future role at a glanceLocation: Remote
Facility: Ascension Network Service
Department: Utilization Management
Schedule: Days l Full Time
Salary range: $84,060.91 - $ 118,668.99 per year (Texas) | Pay ranges vary based on candidate geographic location
How you'll make an impact in this role- Managed admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination.
- Reviewed admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases.
- Collaborated with clinical and administrative teams to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals.
- Coordinated discharge planning with interdisciplinary healthcare teams to ensure appropriate transitions of care and continuity of services.
- Monitored compliance with federal regulations and third-party payer utilization management requirements, while preparing utilization review reports and performance metrics as needed.
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.
Responsibilities- Managed admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination.
- Reviewed admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases.
- Collaborated with clinical and administrative teams to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals.
- Coordinated discharge planning with interdisciplinary healthcare teams to ensure appropriate transitions of care and continuity of services.
- Monitored compliance with federal regulations and third-party payer utilization management requirements, while preparing utilization review reports and performance metrics as needed.
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.
