Registered Nurse – Utilization Review

Ascension

. Reviews admissions and service requests within the assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria .

Posted 11/5/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $78,562 - $110,906 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management, medical necessity reviews, and compliance with reimbursement policies. Proficient in coordinating discharge planning and managing complex cases while ensuring adherence to utilization management regulations.

Highest-signal resume keywords

Registered Nurse CredentialCase ManagementMedical Necessity ReviewUtilization Management ComplianceDischarge Planning Coordination

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

CodingMedical Records DocumentationPrecertificationReimbursementClaim Denials AppealsStatistical AnalysisUtilization Review

Certifications & Qualifications

Texas Board of Nursing Credential

Industry Keywords

Healthcare ComplianceThird-Party Payer RegulationsFederally Mandated Rules

About the role

Key responsibilities & impact

Reviews admissions and service requests within the assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria
Provides case management and/or consultation for complex cases
Assists departmental staff with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals
Assesses and coordinates discharge planning needs with healthcare team members
May prepare statistical analysis and utilization review reports
Oversees and coordinates compliance with federally mandated and third-party payer utilization management rules and regulations

Requirements

What you’ll need

Registered Nurse credentialed from the Texas 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
Must work full-time on the day shift

Benefits

Comp & perks

Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
Employer-matched 403(b)
Planning and hardship resources
Disability and life insurance
Pro-rated paid time off (PTO) and holidays
Ascension-paid tuition (Vocare)
Tuition reimbursement
Ongoing professional development and online learning
Employee Assistance Program
Counseling and peer support
Spiritual care and stress management resources
Parental leave
Adoption assistance and family benefits
Optional legal and pet insurance
Transportation savings