Remote RN: Medical Management & Prior Authorization

bannerhealth; Arizona; Remote; USD 74,000 - 123,000; Full time

Benefits offered by this job

Remote work option

Job summary

Banner Health in Arizona is seeking an experienced RN for Medical Management Services to review and authorize health plan pre-service requests, perform care coordination, and support utilization management. This role emphasizes research using CMS, Noridian, and Encoder Pro, with provider and member outreach as needed.

The position is remote with Monday–Friday 8AM–5PM and Saturday rotations; candidates must reside in AZ and have strong communication, critical thinking, and collaboration skills.

Qualifications

• Requires Registered Nurse licensure in the state of practice with identifying state and expiration date.
• Bachelor’s degree or equivalent experience is required.
• Typically five years of clinical experience are preferred.

Responsibilities

• Process health plan medical pre-service requests and provide case management.
• Perform utilization management and care coordination within required timeframes.
• Interact with providers, vendors, and members to support prior authorization and related services.
• Document interventions accurately in the medical record and ensure quality of service.

Skills

RN Licensure

Care Coordination

Communication

Time Management

Education

Bachelor's degree or equivalent experience

Tools

CMS

Optum360 Encoder Pro

Job description

Banner Health in Arizona is seeking an experienced RN for Medical Management Services to review and authorize health plan pre-service requests, perform care coordination, and support utilization management. This role emphasizes research using CMS, Noridian, and Encoder Pro, with provider and member outreach as needed.

The position is remote with Monday–Friday 8AM–5PM and Saturday rotations; candidates must reside in AZ and have strong communication, critical thinking, and collaboration skills.