Your future role at a glanceLocation: Remote
Facility: Ascension Network Service
Department: Utilization Management
Schedule: Days l Full-Time
Salary range: $78,561.60 - $110,905.60 per year (Texas) | Pay ranges vary based on candidate geographic location
Benefits that help you thrive- Retirement: 403(b) plan
- Well-being support: Employee Assistance Program , counseling and peer support, spiritual care and stress management resources
How you'll make an impact in this role- Provide healthcare services related to admissions, case management, discharge planning, and utilization review.
- Review admissions and service requests for medical necessity, reimbursement compliance, and utilization management criteria.
- Support complex case management and assist staff with coding, documentation, precertification, reimbursement, and denial/appeal issues.
- Coordinate discharge planning needs with patients, providers, and interdisciplinary healthcare teams.
- Ensure compliance with federal regulations and third-party payer utilization management requirements while preparing reports and statistical analyses 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- Provide healthcare services related to admissions, case management, discharge planning, and utilization review.
- Review admissions and service requests for medical necessity, reimbursement compliance, and utilization management criteria.
- Support complex case management and assist staff with coding, documentation, precertification, reimbursement, and denial/appeal issues.
- Coordinate discharge planning needs with patients, providers, and interdisciplinary healthcare teams.
- Ensure compliance with federal regulations and third-party payer utilization management requirements while preparing reports and statistical analyses 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.
