Acute Care Utilization RN Navigator

Valleywise Health; Mesa (AZ); On-site; USD 130,872,000 - 151,536,000; Full time

Job summary

Valleywise Health is seeking an experienced Utilization Review RN Coordinator to join a multidisciplinary team providing inpatient behavioral health services across facilities in Maryvale, Phoenix, and Mesa. You will determine admission appropriateness, ensure accurate documentation, and coordinate care through the continuum to support timely, value-based care.

The role requires a Bachelor’s in Nursing, active AZ RN licensure, at least three years of acute care RN experience, and proficiency

Qualifications

• Bachelor's degree in Nursing and active Arizona RN licensure.
• Minimum 3 years of recent acute RN hospital experience, preferably in case management/utilization.
• Proficiency with Epic, InterQual, Midas and related software is strongly preferred.

Responsibilities

• Determine appropriateness of hospital admissions and medical necessity for continued stay.
• Ensure medical documentation accurately reflects illness severity and acuity.
• Facilitate patient progression through the continuum of care with timely and cost-effective care.
• Collaborate with managed care plans, third-party payers, business office, and interdisciplinary team for authorization and reimbursement.

Skills

Communication skills

Critical thinking

Clinical knowledge

Education

Bachelor's degree in Nursing

Tools

Epic

InterQual

Midas

Job description

Valleywise Health is seeking an experienced Utilization Review RN Coordinator to join a multidisciplinary team providing inpatient behavioral health services across facilities in Maryvale, Phoenix, and Mesa. You will determine admission appropriateness, ensure accurate documentation, and coordinate care through the continuum to support timely, value-based care.

The role requires a Bachelor’s in Nursing, active AZ RN licensure, at least three years of acute care RN experience, and proficiency