RN-Utilization Review

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

Your future role at a glance:

Location:Remote

Facility:Ascension Sacred Heart Hospital

Department:Utilization Management

Schedule:Days | Full - Time

Pay range:$84,060.91 - $118,668.99

How you’ll make an impact in this role:

• Perform prospective, concurrent, and retrospective reviews of admissions and service requests using evidence-based criteria (e.g., InterQual, MCG) to ensure medical necessity and adherence to reimbursement policies.
• Manage and consult on high-acuity or complex cases, coordinating with the multidisciplinary team to ensure the level of care matches the patient’s clinical status and facility protocols.
• Mitigate financial risk by overseeing compliance with federal (CMS) and third‑party payer regulations, assisting staff with precertification, accurate coding, and the management of claim denials or appeals.
• Lead the healthcare team in assessing and coordinating discharge needs, ensuring safe patient transitions while preparing statistical reports to identify trends in resource utilization.

What minimum qualifications you’ll need:

Licensure / Certification / Registration:

• Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire date

or job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State 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.

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 97,000 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:

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.

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, location and salary range at the time of the offer.