Registered Nurse – Utilization Review

🔥 5 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $75.7k - $142.4k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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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

• Reviews admissions and service requests for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria • Provides case management and/or consultation for complex cases • Assists departmental staff with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals • Assesses and coordinates discharge planning needs with healthcare team members • May prepare statistical analysis and utilization review reports • Oversees and coordinates compliance with federally mandated and third-party payer utilization management rules and regulations

🎯 Requirements

• Registered Nurse credentialed from the Wisconsin Board of Nursing obtained prior to hire date or job transfer date • Licensure from the Wisconsin Board of Nursing OR current home state license if considered multi-state/Compact State • Diploma from an accredited school/college of nursing required OR required professional licensure at time of hire

🏖️ Benefits

• 403(b) plan • Employee Assistance Program • Counseling and peer support • Spiritual care and stress management resources

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