Ascension

Registered Nurse Utilization Review

Ascension • $84K — $118K *
US-AnywhereRemote in United States
Healthcare
Less than 5 years of experience
Reposted Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Must possess a valid Registered Nurse license relevant to the working state.
  • Prior experience in case management or healthcare services preferred.
  • Ability to analyze medical necessity and compliance with reimbursement policies.
  • Strong understanding of coding and documentation practices.
  • Experience navigating complex patient cases is advantageous.

Responsibilities

  • Conduct comprehensive clinical reviews for admissions and service requests.
  • Provide specialized case management support for complex situations.
  • Assist teams with coding accuracy and managing claim denials.
  • Evaluate and coordinate discharge planning with healthcare professionals.
  • Ensure compliance with federal regulations and third-party payer requirements.

Benefits

  • Remote work flexibility allows for a better work-life balance.
  • Full-time schedule contributes to predictable work hours.
  • Opportunity to impact patient care and improve healthcare delivery.
  • Professional development opportunities may be available.
  • Collaborative work environment fosters teamwork and support.
Full Job Description
Your future role at a glance

Location: Remote

Department/Specialty: Ascension Care Management Insurance

Schedule: Full Time | Day

Salary: $84,060.91-$118,668.99

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: pro-rated 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


How you'll make an impact in this role

  • Comprehensive Clinical Review: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.
  • Complex Case Navigation: Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.
  • Operational & Denial Support: Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.
  • Strategic Discharge Coordination: Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.
  • Regulatory & Data Oversight: Oversee compliance with federal and third-party payer regulations while producing statistical reports and utilization analyses to track operational performance.

What minimum requirements you'll need

Licensure / Certification / Registration:

  • Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to state in which work is performed.


Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

What additional preferences we're seeking

  • Minimum of 2-3 years of direct experience in utilization management or a managed care environment is required .
  • Health plan/health-care management/leadership experience in related field)
  • Must work independently and as well as collaboratively within a team and attentiveness to details
  • Ability to communicate, facilitate and problem- solve with people of all levels of the organization, as provider engagement and member outreach
  • Ability to solve practical problems and deal with a variety of concrete variables; ability to collect and analyze data, draw valid conclusions and actively contribute to the strategic interventions that support the departmental goals

Responsibilities

  • Comprehensive Clinical Review: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.
  • Complex Case Navigation: Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.
  • Operational & Denial Support: Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.
  • Strategic Discharge Coordination: Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.
  • Regulatory & Data Oversight: Oversee compliance with federal and third-party payer regulations while producing statistical reports and utilization analyses to track operational performance.


Qualifications

Licensure / Certification / Registration:

  • Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to state in which work is performed.


Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

About Ascension

Ascension is a healthcare company that provides a range of services, including hospital care, primary care, and specialty care. The company operates more than 150 hospitals and 50 senior living facilities across the United States. Ascension also offers health insurance and other healthcare-related services. The company was founded in 1999 and is headquartered in St. Louis, Missouri.
Learn more about Ascension
Size
165,000 employees
Industry
Healthcare
Founded
1999
* Ladders Estimates

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