RN - Utilization Review & Case Management

Pacer Group; Austin (TX); On-site; USD 48,000 - 68,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401(K)

Job summary

Pacer Group in Austin, TX seeks a qualified Utilization Management RN to join our centralized UM team across acute care facilities. The role centers on admissions, discharge planning, and utilization review in a fast-paced setting.

Responsibilities include reviewing medical necessity for prospective, concurrent, and retrospective requests, navigating CMS regulations and InterQual/MCG criteria, and assisting with coding, documentation, and payer communications.

Qualifications

• Licensed RN with multi-state or TX license required.
• At least 2 years acute care UM experience or equivalent.
• Proficient with InterQual, MCG, and CMS regulations.
• Experience with payer portals and managed Medicare/Medicaid preferred.
• Familiarity with Google Workspace; remote work experience a plus.

Responsibilities

• Provides admissions, case management, discharge planning and utilization review.
• Reviews admissions and service requests for medical necessity and reimbursement policy.
• Assists coding, medical records/documentation, precertification, reimbursement, and denials/appeals.
• Coordinates discharge planning with the healthcare team.
• May prepare utilization review reports as necessary.
• Oversees compliance with payer utilization management rules and regulations.

Skills

Licensed RN

Utilization Management

InterQual/MCG

CMS regulations

Remote work experience

Education

RN license (multistate or TX)

Tools

Cerner

Careport (Allscripts)

Google Workspace

Job description

Pacer Group in Austin, TX seeks a qualified Utilization Management RN to join our centralized UM team across acute care facilities. The role centers on admissions, discharge planning, and utilization review in a fast-paced setting.

Responsibilities include reviewing medical necessity for prospective, concurrent, and retrospective requests, navigating CMS regulations and InterQual/MCG criteria, and assisting with coding, documentation, and payer communications.