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Rn Utilization Management Jobs

Company

Ascension
Address , Bulverde, 78163, Tx
Employment type FULL_TIME
Salary From $69,555 a year
Expires 2023-07-22
Posted at 1 year ago
Job Description
We Are Hiring:
  • Department: Ascension Care Management Insurance
  • Location: Texas Resident; Remote
  • Schedule: Monday - Friday 8-5 PM CST
What You Will Do:
Ascension is seeking Utilization Review Nurses with InterQual or MCG experience to join the team in Texas! As a Utilization Review RN supporting programs of Dell Children's Health Plan (DCHP) , you will have the opportunity to provide health care services regarding admissions, case management, discharge planning and utilization review. Other responsibilities include:
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • Provide case management and/or consultation for complex cases.
  • May prepare statistical analysis and utilization review reports as necessary.
What You Will Need:
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.
Additional Preferences:
  • Current resident of Texas with an active compact TX RN license
  • InterQual or MCG experience
  • Health plan or inpatient utilization experience
  • BSN with at least 3 years of nursing experience
Why Join Our Team:
Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
Equal Employment Opportunity Employer:
Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran 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.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement:
This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.
E-Verify

Salary Description: Minimum Salary: $69,555.20+ per year