Registered Nurse Utilization Review

Ascension; Nashville (TN); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Retirement plan (403(b))

Tuition reimbursement and professional

Professional development

Paid time off

Job summary

Ascension is seeking a remote Case Management RN to review admissions and service requests for medical necessity, coordinate discharge planning, and assist staff with coding, documentation, precertification, reimbursement and denials/appeals. The role requires TN RN licensure and nursing education, with opportunities to contribute to utilization reviews.

You will collaborate with the healthcare team in a full-time, days schedule within the Case Management department, supporting Ascension St

Qualifications

• Nursing licensure in Tennessee is required prior to hire.
• Diploma or equivalent nursing education is required.
• Experience in case management or discharge planning is a plus.

Responsibilities

• Review admissions and service requests for medical necessity and policy compliance.
• Coordinate discharge planning and collaborate with healthcare team.
• Assist staff with coding, documentation, precertification, reimbursement, and denials/appeals.
• Prepare basic utilization reviews or statistical analyses as needed.
• Ensure compliance with federal and payer utilization management rules.

Education

Diploma from an accredited school/college of nursing

RN license in TN

Job description

• Reviews admissions and service requests within assigned unit 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 issues related to 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 as necessary.
• Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.

Your future role at a glance

Location: Remote

Facility: Ascension St Thomas

Department: Case Management

Schedule: Full-Time | Days

How you’ll make an impact in this role

• Reviews admissions and service requests within assigned unit 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 issues related to 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 as necessary.
• Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.

What Minimum Requirements You’ll Need

Licensure / Certification / Registration

• Required Credential(s):
• Licensed Compact State Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date.

Education

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

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

Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

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