Utilization Review Nurse

We Are Hiring

Location: Remote

Facility: Ascension Saint Thomas

Department: Utilization Management

Schedule: Part Time | Weekends

Salary: $78,561.60 - $110,905.60 per year

What You Will Do

• Admissions & Medical Necessity Review: Evaluating service requests and admissions for medical necessity using evidence-based tools (like InterQual) to ensure they comply with reimbursement policies.
• Case Management & Consultation: Providing coordination and consultation for complex cases to enhance clinical outcomes and manage the cost of care.
• Administrative & Billing Support: Assisting staff with medical documentation, coding, precertification, and managing claim denials or appeals.
• Discharge Planning: Assessing and coordinating a patient's post-hospital needs, such as home health, medical equipment, or transfers to skilled nursing facilities.
• Compliance & Reporting: Overseeing adherence to federal (CMS) and third-party payer regulations and preparing statistical analysis on resource utilization.

What You Will Need

Licensure / Certification / Registration:

• Licensed Registered Nurse credentialed from the Tennessee 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

Utilization Management experience is preferred.

Why Join Our Team

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ 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.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

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Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays 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.