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 11/12/2026part-timeRemote • Wisconsin • United StatesMid-LevelSenior💰 $75,655 - $142,403 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

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

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 Appeals

Soft Skills

CollaborationCommunicationAssessment

Certifications & Qualifications

Wisconsin Board of Nursing Licensure

Industry Keywords

HealthcareDischarge PlanningUtilization ReviewThird-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 Wisconsin Board of Nursing obtained prior to hire date or job transfer date
Licensure from the Wisconsin Board of Nursing OR current home state license if considered multi-state/Compact State
Diploma from an accredited school/college of nursing required OR required professional licensure at time of hire

Benefits

Comp & perks

403(b) plan
Employee Assistance Program
Counseling and peer support
Spiritual care and stress management resources