Remote RN - Utilization Review & Case Management

Ascension; Austin (TX); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Comprehensive health coverage

Employer-matched 403(b) retirement

Pro-rated PTO and holidays

Tuition reimbursement (Ascension-paid)

Employee Assistance Program

Parental leave and adoption assistance

Transportation savings

Job summary

Ascension is seeking a Utilization RN to review admissions and service requests for medical necessity and reimbursement criteria in a remote setting. You will provide case management and consultation for complex cases and coordinate with the healthcare team.

The role supports coding, medical records, precertification, reimbursement, and appeals, assesses discharge planning needs, and may prepare utilization review reports. You will ensure compliance with federal and third-party payer rules.

Qualifications

• RN credential from Texas Board of Nursing required.
• Diploma from an accredited nursing school required or active licensure at time of hire.
• Experience with admissions, discharge planning, and care coordination is desirable.

Responsibilities

• Reviews admissions and service requests for medical necessity and reimbursement policy adherence.
• Assists staff with coding, medical records, precertification, reimbursement and denial/appeal issues.
• Assesses and coordinates discharge planning with the healthcare team.
• May prepare statistical analysis and utilization review reports as needed.
• Oversees compliance with federally mandated and third-party payer utilization management rules.

Skills

Case management

Discharge planning

Healthcare coordination

Reimbursement knowledge

Education

Diploma in nursing

Texas RN licensure

Job description

Ascension is seeking a Utilization RN to review admissions and service requests for medical necessity and reimbursement criteria in a remote setting. You will provide case management and consultation for complex cases and coordinate with the healthcare team.

The role supports coding, medical records, precertification, reimbursement, and appeals, assesses discharge planning needs, and may prepare utilization review reports. You will ensure compliance with federal and third-party payer rules.