Remote Utilization Review Rn Jobs (NOW HIRING)

Location: Remote

Department/Specialty: Ascension Care Management Insurance

Schedule: Full Time | Days

Salary: $84,060.91-$118,668.99

• 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.
• Regulatory & Data Oversight: Oversee compliance with federal and third-party payer regulations while producing statistical reports and utilization analyses to track operational performance.

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.

• Minimum of 2-3 years of direct experience in utilization management or a managed care environment is required.
• Health plan/health-care management/leadership experience in related field)
• Must work independently and as well as collaboratively within a team and attentiveness to details 
• Ability to communicate, facilitate and problem- solve with people of all levels of the organization, as provider engagement and member outreach
• Ability to solve practical problems and deal with a variety of concrete variables; ability to collect and analyze data, draw valid conclusions and actively contribute to the strategic interventions that support the departmental goals

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.