Remote Utilization Review Rn Jobs in Pensacola, FL

Location: Remote

Facility: Ascension Sacred Heart Hospital 

Department: Utilization Review

Schedule: Days | Full - Time

Pay range: $84,060.91 - $118,668.99

• 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.

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.

• 3+ years of clinical experience required, Observation experience 
• Experience in Utilization Management, Case Management, or Care Coordination 
• Experience working in a remote environment

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

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.

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.