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Utilization Review RN

2 months ago

Austin TX United States Ascension Seton Northwest Full time
Utilization Review RN

Details * Department: Utilization Review * Schedule: Full-time, 8-hour day shift, Monday-Friday, Remote, including occasional on-site needs, weekends and holidays required * Facility: Ascension Care Management Insurance 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 * Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics. Responsibilities As the Utilization Review RN, you'll provide health care services regarding admissions, case management, discharge planning and utilization review. * Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. * Provide case management and/or consultation for complex cases. * Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. * Assess and coordinate discharge planning needs with health-care team members. * May prepare statistical analysis and utilization review reports as necessary. * Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. Requirements Licensure / Certification / Registration: * Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to state in which work is performed. Education: * Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. Additional Preferences Additional Preferences: * RN Compact License, required * Bachelors in Nursing, preferred * 3 years of clinical experience, preferred * 2-3 years of utilization managment and managed care experience, preferred #LI-Remote Why Join Our Team Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you. Equal Employment Opportunity Employer Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran 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. As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension. Pay Non-Discrimination Notice Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. E-Verify Statement This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. E-Verify