Registered Nurse Utilization Review

 Posted 5 days ago
     
2-5 years experience
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AI Summary

The role focuses on validating medical necessity and coordinating patient transitions to ensure high-quality care and reduce readmissions. Additionally, it involves managing the appeals process and enforcing clinical standards to maximize organizational revenue and operational efficiency.

We Are Hiring

Location: Remote

Facility: Ascension St. John Medical Center

Department/Specialty: Utilization Review

Schedule: PRN, Every other weekend, 8am-430pm

What You Will Do

  • Secures Patient-Centered Care: Ensures the right care at the right time by validating medical necessity, advocating for benefits, and coordinating smooth, safe transitions to reduce readmissions.
  • Maximizes Financial Health: Protects and maximizes organizational revenue by preventing claim denials, ensuring proper status designation for reimbursement, and managing the appeals process.
  • Drives Operational Efficiency: Streamlines hospital workflows and the progression of care by coordinating with multidisciplinary teams and ensuring the responsible, judicious allocation of high-cost resources.
  • Upholds Quality and Compliance: Mitigates regulatory risk by enforcing evidence-based clinical standards (e.g., InterQual) and ensuring compliance with all governmental and third-party payer regulations.

What You Will Need

Licensure / Certification / Registration:

  • Registered Nurse credentialed from the Oklahoma Board of Nursing obtained prior to hire date or jobtransfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Additional Preferences

  • Active Oklahoma Nursing License
  • 3+ years of Nursing experience
  • Utilization Management experience preferred

Why Join Our Team

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

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.

 

Benefits

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.

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