RN-Utilization Review

Healthcare Ascension; Indianapolis (IN); Remote; USD 60,000 - 90,000; Full time

Job summary

Join a forward-thinking healthcare organization as a Utilization Review Nurse, where you will ensure effective use of healthcare resources while working remotely. This role involves assessing patient medical records for compliance with clinical guidelines and collaborating with healthcare teams to optimize patient care. With a commitment to high-quality standards, you will play a crucial part in enhancing patient outcomes. Enjoy a competitive salary, flexible hours, and opportunities for professional growth in a supportive environment dedicated to community impact.

Benefits

Paid Time Off (PTO)

Health Insurance Options

Retirement Benefits

Tuition Reimbursement

Employee Assistance Programs

Parental Leave

Flexible Work Hours

Qualifications

• Active Indiana RN License required.
• 3 years bedside experience in relevant fields preferred.

Responsibilities

• Provide healthcare services regarding admissions and case management.
• Review admissions for medical necessity and compliance.

Skills

Utilization Management

Case Management

Patient Assessment

Coding Knowledge

Discharge Planning

Education

Bachelors in Nursing

Registered Nurse License

Job description

Details

• Department:Utilization Management
• Schedule: Monday-Friday 8.00am-5.00pm EST with rotating weekends and holidays
• Hospital:Ascension St. Vincent
• Location:Indianapolis, IN

Active Indiana or compact RN License.

Bachelors in Nursing

3 years of bedside experience in Medical Surgical, ICU, Emergency Room or Case Management required.

A minimum of 5 years Utilization Management experience also preferred.

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:

• Registered Nurse credentialed from the Indiana Board of Nursing 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 required.

Additional Preferences

We are seeking a dedicated, detail-oriented, and self-motivated Utilization Review Nurse to join our healthcare team. This remote position is crucial to ensuring the appropriate, efficient, and cost-effective use of healthcare resources. The Utilization Review Nurse will be responsible for reviewing patient medical records to assess compliance with clinical guidelines, insurance criteria, Medicare regulations, and overall best practices.The ideal candidate will be an experienced utilization review nurse who has shown the ability to maintain high quality standards, form collaborative relationships and adapt to changes within a rapidly evolving healthcare environment.

Why Join Us:

• Be part of a high performing team committed to providing high-quality patient care while optimizing healthcare resources.

• Competitive salary and benefits package.

• Work from the comfort of your home with flexible hours.

• Continuous professional development and career growth opportunities.

Work Environment:

• Remote position with flexibility.

• Must have a reliable Internetconnection and appropriate workspace for confidential and professional work.

Why Join Our Team

Ascension St. Vincent in Indiana has been providing rewarding careers in healthcare for over 148 years. With 24 hospitals throughout the greater Indianapolis and Evansville areas, Ascension St. Vincent offers careers in a wide range of services including acute and long-term care, bariatrics, cancer care, cardiovascular services, emergency services, neuroscience, orthopedics, pediatric services, primary and urgent care, women's health services and more.

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 will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran 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.

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

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 employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

E-Verify

Licensure / Certification / Registration:

• Registered Nurse credentialed from the Indiana Board of Nursing 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 required.

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.