Registered Nurse – Utilization Review

Ascension

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

Posted 10/30/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $84,061 - $118,669 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity reviews, case management, 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 ComplianceStatistical Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CodingMedical Records DocumentationPrecertificationReimbursementClaim Denials Appeals

Soft Skills

CollaborationCommunicationAssessment

Certifications & Qualifications

Texas Board of Nursing Credential

Industry Keywords

HealthcareUtilization ReviewDischarge PlanningThird-Party Payer Compliance

About the role

Key responsibilities & impact

Reviews admissions and service requests 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

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