Remote RN: Medical Management & Prior Authorization

Banner Health; Arizona; Hybrid; USD 48,000 - 81,000; Full time

Job summary

Banner Health is seeking an experienced RN for Medical Management Services in a remote-capable role based in AZ. The position focuses on pre-service reviews, case management, and utilization management within an evidence-based framework.

You will interact with providers, vendors, and members while supporting health plan consumer outcomes. The ideal candidate has five years of clinical experience, strong communication, and the ability to work in an interdisciplinary team with flexible hours,

Qualifications

• Requires RN licensure in the state of practice (AZ).
• Bachelor's degree or equivalent experience.
• Requires five years of clinical experience.
• Knowledge of care management, acute/home care environments, and utilization management.
• Strong communication, problem-solving, and time management skills.
• Ability to work in an interdisciplinary team and flexible hours with rotating call.

Responsibilities

• Manage health plan consumer/beneficiaries across the care continuum to optimize outcomes.
• Provide pre-service determinations, concurrent review, and case management functions.
• Collaborate with internal/external stakeholders on prior authorization and utilization management.
• Transfer accurate patient information for pre-service determinations and care transitions; document interventions.
• Evaluate medical necessity and potential delays; refer to case management as needed.
• Educate internal/external stakeholders on population health and evidence-based practices.
• Refer requests to Medical Director when guidelines are not clearly met; participate in rotation calls.
• Maintain knowledge of plan documents and authorization requirements; follow applicable regulations.

Skills

Care Management Knowledge

Critical Thinking

Communication Skills

Time Management

Interdisciplinary Teamwork

Flexible Hours

Education

Bachelor's degree or equivalent experience

Job description

Banner Health is seeking an experienced RN for Medical Management Services in a remote-capable role based in AZ. The position focuses on pre-service reviews, case management, and utilization management within an evidence-based framework.

You will interact with providers, vendors, and members while supporting health plan consumer outcomes. The ideal candidate has five years of clinical experience, strong communication, and the ability to work in an interdisciplinary team with flexible hours,