Registered Nurse Utilization Review
Murfreesboro, Tennessee
You'll review admissions and service requests for medical necessity and reimbursement compliance.
- Shift and hours
- Days Schedule: Full-Time | Days
- Unit and setting
- assigned unit Reviews admissions and service requests within assigned unit
- License
- RN license Registered Nurse obtained prior to hire date or job transfer date.Registered Nurse license before hire
- Term
- Permanent Schedule: Full-Time | DaysFull-time
Do you qualify?
- License
- Registered Nurse license before hire Registered Nurse obtained prior to hire date or job transfer date.
- Education
- accredited nursing diploma, or required professional licensure at hire
Preferred
- Certification
- BLS Provider (AHA or Red Cross accepted)
What it pays
- Against similar roles
- Tennessee staff median is $82k/yrTennessee staff postings that state pay run $54k/yr to $103k/yr, the middle half $69k/yr to $94k/yr, across 491 postings. This posting's $76k/yr to $142k/yr is wider than that, so where you land depends on the offer.
The role and schedule
- Day to day
- case management and consults on complex cases Provides case management and/or consultation for complex cases.
- Day to day
- helping staff with coding, precertification and claim denials/appeals Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Day to day
- discharge planning with the healthcare team Assesses and coordinates discharge planning needs with healthcare team members.
- Day to day
- utilization review reports and statistical analysis May prepare statistical analysis and utilization review reports as necessary.
- Day to day
- compliance with federal and payer utilization management rules Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
- Hours stated
- Full-Time | Days
- Details
- Remote position Location: Remote
- Details
- Saint Thomas Ascension facility Facility: Saint Thomas Ascension
The workplace
Ask Mira
Your fit
Questions to ask
- Can you walk me through differentials?
- What should I expect for weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
On your path
Case Management is a specialty you move into. Bedside years first. That experience is what gets you in.
Original listing
Posted on Ascension’s careers page.
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- Facility
- Saint Thomas Ascension
- Department
- Case Management
- Schedule
- Full-Time | Days
Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
Licensure / Certification / Registration Required Credential(s): Registered Nurse obtained prior to hire date or job transfer date. Preferred Credential(s): BLS Provider. American Heart Association or American Red Cross accepted.
Education Diploma from an accredited school/college of nursing required. OR Required professional licensure at time of hire.
What's around it?
Murfreesboro, TNFrom Census ACS 2024.
Living costs about 4% below the US average
- Median rent
- $1,481/mo
- Household income
- $80,108/yr, all local households, not nurse pay