[Hiring] Registered Nurse Utilization Review @Ascension

Role Description

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.

Qualifications

• Registered Nurse credentialed from the Oklahoma Board of Nursing obtained prior to hire date or job transfer date required.
• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
• Active Oklahoma Nursing License.
• 3+ years of Nursing experience.
• Utilization Management experience preferred.

Benefits

• Paid time off (PTO)
• Various health insurance options & wellness plans
• Retirement benefits including employer match plans
• Long-term & short-term disability
• Employee assistance programs (EAP)
• Parental leave & adoption assistance
• Tuition reimbursement
• Ways to give back to your community