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About the Role
Managed admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination. Reviewed admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases. Collaborated with clinical and administrative teams to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals. Coordinated discharge planning with interdisciplinary healthcare teams to ensure appropriate transitions of care and continuity of services. Monitored compliance with federal regulations and third-party payer utilization management requirements, while preparing utilization review reports and performance metrics as needed.
Responsibilities
- Managed admissions, case management, discharge planning, and utilization review to support quality patient care and efficient care coordination.
- Reviewed admissions and service requests for medical necessity, reimbursement compliance, and utilization management, while providing case management support for complex cases.
- Collaborated with clinical and administrative teams to resolve issues related to coding, medical documentation, precertification, reimbursement, and claim denials or appeals.
- Coordinated discharge planning with interdisciplinary healthcare teams to ensure appropriate transitions of care and continuity of services.
- Monitored compliance with federal regulations and third-party payer utilization management requirements, while preparing utilization review reports and performance metrics as needed.
Requirements
- Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" 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.
Location
- Remote
Work Type
- Full Time
Education Level
- Diploma from an accredited school/college of nursing
- Required professional licensure at time of hire
Salary/Compensations
- $84,060.91- $118,668.99 per year (Texas)
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
About the Company
- 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 Opportunity
- 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.