Travel Nurse RN - Utilization Review
Austin, TX
Care Career
5x8 hrs, Days
Referral Bonus

🏥 Job Breakdown – Utilization Management RN

Position: Utilization Management (UM) RN
Facility: Ascension Texas
Department: Centralized Utilization Management
Work Setting: Fully Remote
Shift: 8:30 AM – 5:00 PM
Contract: 13 weeks
 

💼 What the RN Will Do

This is not bedside nursing. The RN will work in Utilization Management, reviewing patient admissions and services to determine medical necessity and insurance compliance.

Main responsibilities:

• Review hospital admissions for medical necessity
• Perform prospective, concurrent, and retrospective reviews
• Review service requests against payer criteria
• Provide case management/consultation for complex cases
• Review medical records and documentation
• Assist with:
  • Coding issues
  • Precertification
  • Reimbursement
  • Claim denials
  • Appeals
• Coordinate discharge planning with the healthcare team
• Prepare utilization review/statistical reports when needed
• Ensure compliance with CMS and third-party payer requirements

🏥 Department Details

• Centralized UM department
• Handles acute admission utilization review for 13 acute-care and critical-access hospitals
• No patient-bed assignment
• No scrubs required
• No floating to other units
• UM Managers: Pam Long and Jennifer Liles
• UM Assistants support the department

📋 Required Qualifications

Must have:

• Active RN license
  • Multistate/Compact or
  • Texas RN license
• 2 years of acute-care Utilization Management experience or equivalent
• Experience with:
  • InterQual
  • MCG
  • CMS regulations
• Ability to work independently with minimal supervision
• Strong critical-thinking and decision-making skills

⭐ Preferred Experience

Candidates are stronger if they have:

• Payer/insurance portal experience
• Managed Medicare experience
• Medicaid insurance experience
• Remote-work experience
• Google Workspace experience
• Ability to work with multiple technologies simultaneously

💻 EMR / Technology

• Cerner
• Careport (Allscripts)
• InterQual / MCG
• Multiple technology platforms used simultaneously