Registered Nurse – Utilization Review

This is a fully remote position, open to applicants in Texas.

📋 Description

• Evaluates admissions and service requests within the designated unit for prospective, concurrent, and retrospective medical necessity and/or adherence to reimbursement policy criteria.

• Offers case management and/or expert consultation for complex cases.

• Aids departmental personnel with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals.

• Evaluates and organizes discharge planning requirements in collaboration with healthcare team members.

• May compile statistical analyses and utilization review reports.

• Supervises and coordinates adherence to federally mandated and third-party payer utilization management rules and regulations.

⛳️ Requirements

• Registered Nurse credential from the Texas Board of Nursing, obtained prior to the hire date or job transfer date.

• Graduation from an accredited nursing school/college required, or necessary professional licensure at the time of hire.

• Must work full-time during the day shift.

🏝️ Benefits

• Comprehensive health coverage including medical, dental, vision, prescription coverage, and HSA/FSA options.

• Employer-matched 403(b) retirement plan.

• Access to planning and hardship resources.

• Disability and life insurance coverage.

• Pro-rated paid time off (PTO) and holidays.

• Ascension-funded tuition (Vocare) program.

• Tuition reimbursement opportunities.

• Continuous professional development and online learning resources.

• Employee Assistance Program for support.

• Counseling and peer support services.

• Resources for spiritual care and stress management.

• Parental leave benefits.

• Adoption assistance and family benefits available.

• Optional legal services and pet insurance.

• Transportation savings programs.