The Leader in Faith Formation
Utilization Management Nurse
Location
United States
Posted
27 days ago
Salary
$78.6K - $110.9K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Management Nurse
Ascension
Role Description Your future role at a glance: - Location: Remote - Facility: Ascension St Thomas - Department: Utilization Management - Schedule: Full Time | Days - Salary: $78,561.60 - $110,905.60 per year How you’ll make an impact in this role: - 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. Qualifications - Licensure / Certification / Registration: Required Credential(s): 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. - Education: Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. Requirements - Utilization Management experience is preferred. Benefits - Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options - Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance - Time to recharge: pro-rated paid time off (PTO) and holidays - Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning - Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources - Family support: parental leave, adoption assistance and family benefits - Other benefits: optional legal and pet insurance, transportation savings and more Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.
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