Registered Nurse – Utilization Review
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Job Description
Utilization Review RN evaluating medical necessity, complex cases, and reimbursement compliance for Ascension, a nonprofit Catholic health system. Coordinating discharge planning and resolving documentation, coding, and claims issues.
Responsibilities:
- Review admissions and service requests 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 coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals
- Assess and coordinate discharge planning needs with healthcare team members
- Prepare statistical analysis and utilization review reports as necessary
Requirements:
- Licensed Compact State Registered Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date
- Diploma from an accredited school/college of nursing required OR required professional licensure at time of hire
- Experience evaluating medical necessity, managing complex cases, and ensuring compliance with payer reimbursement policies and regulatory standards
- Experience coordinating comprehensive discharge planning
- Experience resolving documentation and coding challenges
- Experience supporting healthcare teams to optimize patient care and operational efficiency
Benefits:
- 403(b) plan
- Employee Assistance Program
- Counseling and peer support
- Spiritual care
- Stress management resources
- Remote work arrangement
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