Registered Nurse Utilization Review at Ascension

Pensacola, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Oct, 26

Salary

118668.99

Posted On

21 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Review, Medical Necessity Assessment, InterQual, MCG, Case Management, Care Coordination, CMS Regulations, Claim Denials Management, Discharge Planning, Clinical Review, Coding Compliance, Resource Utilization Analysis

Industry

Hospitals and Health Care

Description

Your future role at a glance Location: Remote Facility: Ascension Sacred Heart Hospital Department: Utilization Review Schedule: Days | Full - Time Pay range: $84,060.91 - $118,668.99 How you'll make an impact in this role Perform prospective, concurrent, and retrospective reviews of admissions and service requests using evidence-based criteria (e.g., InterQual, MCG) to ensure medical necessity and adherence to reimbursement policies. Manage and consult on high-acuity or complex cases, coordinating with the multidisciplinary team to ensure the level of care matches the patient’s clinical status and facility protocols. Mitigate financial risk by overseeing compliance with federal (CMS) and third-party payer regulations, assisting staff with precertification, accurate coding, and the management of claim denials or appeals. Lead the healthcare team in assessing and coordinating discharge needs, ensuring safe patient transitions while preparing statistical reports to identify trends in resource utilization. What minimum qualifications you'll need Licensure / Certification / Registration: Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire dateor job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State Board ofNursing or current home state license for multi-state license recognition "Compact State" obtainedprior to hire date or job transfer date required. Education: Diploma from an accredited school/college of nursing OR Required professional licensure at time ofhire. What additional requirements you'll need 3+ years of clinical experience required, Observation experience Experience in Utilization Management, Case Management, or Care Coordination Experience working in a remote environment Life at Ascension: Where purpose meets opportunity Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ 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. E-Verify statement Employer participates in the Electronic Employment Verification Program. Please click here for more information. 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.

Responsibilities

Perform prospective, concurrent, and retrospective reviews of admissions using evidence-based criteria to ensure medical necessity. Coordinate with multidisciplinary teams to manage complex cases and oversee compliance with federal and third-party payer regulations.