RN-Utilization Review

AECOM; Cedar Park (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

AECOM is seeking a dedicated Registered Nurse to join our Utilization Management team. The role involves providing comprehensive healthcare services, including case management and utilization review, ensuring compliance with medical necessity standards. As part of a renowned healthcare organization, you will contribute to patient care, working closely with healthcare teams to enhance service delivery.

Benefits

Paid time off (PTO)

Health insurance options & wellness plans

Retirement benefits with employer match

Long-term & short-term disability

Employee assistance programs (EAP)

Parental leave & adoption assistance

Tuition reimbursement

Qualifications

• Licensed Registered Nurse credentialed from the Texas Board of Nursing.
• Required professional licensure at time of hire.
• Experience in healthcare settings preferred.

Responsibilities

• Provide health care services regarding admissions and case management.
• Assist departmental staff with coding and reimbursement issues.
• Coordinate discharge planning needs with healthcare team members.

Skills

Case Management

Healthcare Compliance

Medical Necessity Review

Education

Diploma from an accredited school/college of nursing

Job description

**Details**

+ **Department:** Utilization Management

+ **Schedule:** FT - Days

+ **Location:** Remote - **Must live within 60 miles of Texas Administrative Offices.**

**Benefits**

Paid time off (PTO)

Various health insurance options & wellness plans

Retirement benefits including employer match plans

Long-term & short-term disability

Employee assistance programs (EAP)

Parental leave & adoption assistance

Tuition reimbursement

Ways to give back to your community

_Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer._

**Responsibilities**

Provide health care services regarding admissions, case management, discharge planning and utilization review.

+ Review admissions and service requests within assigned unit 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 issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.

+ Assess and coordinate discharge planning needs with healthcare team members.

+ May prepare statistical analysis and utilization review reports as necessary.

+ Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

**Requirements**

Licensure / Certification / Registration:

+ Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.

Education:

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

**Additional Preferences**

No additional preferences.

**Why Join Our Team**

Ascension Seton, based in Austin, Texas, has provided thousands of associates and caregivers a rewarding career in healthcare since 1902. Ascension Seton operates more than 100 clinical locations in Central Texas and four teaching hospitals, including Dell Seton Medical Center at The University of Texas and Dell Children's Medical Center. Join us and create a career path you will love.

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

**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) (https://www.eeoc.gov/sites/default/files/2022-10/22-088\_EEOC\_KnowYourRights\_10\_20.pdf) poster or EEO Know Your Rights (Spanish) (https://www.eeoc.gov/sites/default/files/2022-10/22-088\_EEOC\_KnowYourRightsSp\_10\_20.pdf) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice (https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp\_%20English\_formattedESQA508c.pdf)

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

**This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.**