Registered Nurse – Utilization Review

🔥 16 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

💵 $36 - $68 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Ascension

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the U. S. , Ascension is committed to delivering compassionate, personalized care to all, particularly focusing on those living in poverty and the most vulnerable populations. Operating over 2,600 sites of care, including 151 hospitals, Ascension offers a variety of services, including physician practice management and clinical care management, while emphasizing a mission of community benefit.

📋 Description

• Review admissions and service requests 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 coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals • Assess and coordinate discharge planning needs with healthcare team members • Prepare statistical analysis and utilization review reports as necessary

🎯 Requirements

• Licensed Compact State Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date • Diploma from an accredited school/college of nursing required OR required professional licensure at time of hire • Experience evaluating medical necessity, managing complex cases, and ensuring compliance with payer reimbursement policies and regulatory standards • Experience coordinating comprehensive discharge planning • Experience resolving documentation and coding challenges • Experience supporting healthcare teams to optimize patient care and operational efficiency

🏖️ Benefits

• 403(b) plan • Employee Assistance Program • Counseling and peer support • Spiritual care • Stress management resources • Remote work arrangement

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