Day Shift | PRN until 12/31/26 #LI-Remote 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. Health plan or inpatient utilization experience and InterQual or MCG experience.
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 the state in which work is performed.
Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. Preferred
Health plan or inpatient utilization experience preferred InterQual or MCG experience preferred Minimum of 3 years nursing experience preferred Nursing Licensure Compact (NLC) strongly preferred Benefits that help you thrive Retirement: 403(b) plan Well-being support: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources 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. 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.
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