440932
Your future role at a glance
Location: Remote
Facility: Ascension Care Management Insurance
Department: Utilization Review
Schedule: Day Shift | Full Time | Monday-Friday
Salary: $78,561.60 – $110,905.60 (per year)
#LI-Remote
#LI-AM2
Life at Ascension: Where purpose meets opportunity
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ 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.
Benefits that help you thrive
- Comprehensive health coverage:medical, dental, vision, prescription coverage and HSA/FSA options
- Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
- Time to recharge: pro-rated paid time off (PTO) and holidays
- Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
- Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
- Family support:parental leave, adoption assistance and family benefits
- Other benefits: optional legal and pet insurance, transportation savings and more
Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.
How you’ll make an impact in this role
- Comprehensive Clinical Review: Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests to ensure alignment with clinical criteria and reimbursement policies.
- Complex Case Navigation: Provide high-level case management and specialized consultation for complex patient cases to optimize care delivery and resource utilization.
- Operational & Denial Support: Assist interdisciplinary teams with coding, clinical documentation accuracy, precertification, and the management of claim denials or appeals.
- Strategic Discharge Coordination: Evaluate and coordinate discharge planning requirements in collaboration with the healthcare team to ensure safe and timely patient transitions.
- Regulatory & Data Oversight: Oversee compliance with federal and third-party payer regulations while producing statistical reports and utilization analyses to track operational performance.
What minimum requirements you’ll 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.
What additional preferences we’re seeking
- Minimum of 2–3 years of direct experience in utilization management or a managed care environment is required.
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.
