RN Utilization Review

Your future role at a glance

• Location:

Remote

• Department:

Ascension Care Management Insurance - Utilization Review

• Schedule:

Day Shift | PRN until 12/31/26

How you’ll make an impact in this role

• Comprehensive Clinical Review: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.
• Complex Case Navigation: Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.
• Operational & Denial Support: Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.
• Strategic Discharge Coordination: Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.
• Health plan or inpatient utilization experience and InterQual or MCG experience.

What minimum requirements you’ll need

Licensure / Certification / Registration

• Registered Nurse obtained prior to hire date or job transfer date required. Licensure required relevant to the state in which work is performed.

Education

• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Preferred Experience

• Health plan or inpatient utilization experience preferred
• InterQual or MCG experience preferred
• Minimum of 3 years nursing experience preferred
• Nursing Licensure Compact (NLC) strongly preferred

Benefits that help you thrive

• Retirement:

403(b) plan

• Well-being support:

Employee Assistance Program, counseling and peer support, spiritual care and stress management resources

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 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

Fraud prevention notice

E-Verify statement