Remote RN Utilization Review Specialist

Ascension; Milton (FL); On-site; USD 84,000 - 119,000; Full time

Benefits offered by this job

Paid time off

Health insurance

Retirement benefits

Disability coverage

Employee assistance program

Parental leave

Tuition reimbursement

Community involvement

Job summary

Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies.

Join a multidisciplinary team, coordinate with care teams, oversee CMS and payer regulations, and help with precertifications, denials, and discharge planning. This role emphasizes safe transitions and data-driven reporting.

Qualifications

• Licensed Registered Nurse credentialed from the Florida Board of Nursing prior to hire date.
• Florida RN licensure or multi-state Compact license valid upon hire.
• Graduation from an accredited school of nursing.

Responsibilities

• Perform prospective, concurrent, and retrospective reviews of admissions and service requests to ensure medical necessity.
• Manage and consult on high-acuity or complex cases with the multidisciplinary team.
• Oversee compliance with CMS and payer regulations, assisting with precertification and denials/appeals.
• Lead discharge planning and prepare reports on resource utilization trends.

Skills

Evidence-based reviews

Case management

Regulatory compliance

Education

Diploma in Nursing

Job description

Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies.

Join a multidisciplinary team, coordinate with care teams, oversee CMS and payer regulations, and help with precertifications, denials, and discharge planning. This role emphasizes safe transitions and data-driven reporting.