Remote RN - Medical Management & Prior Authorization

Banner Health; Phoenix (AZ); On-site; USD 4,881,000 - 8,135,000; Full time

Job summary

Banner Health is seeking an experienced RN in Medical Management to focus on prior authorization in a remote position. The role involves reviewing cases with clinical guidelines, collaborating with providers, and documenting activities to support cost-effective care.

The role operates Monday–Friday, AZ time, with rotating weekends. Ideal candidates hold an AZ RN license, a BSN or equivalent, and have at least five years of clinical experience.

Qualifications

• Requires RN licensure in the practicing state and a bachelor’s degree or equivalent experience.
• Five years of clinical experience is typically required.
• Comfort with independent work in a remote environment and cross-functional collaboration.

Responsibilities

• Review health plan medical pre-service requests against guidelines.
• Perform concurrent review and care coordination functions.
• Document prior authorization activities accurately in medical records.
• Collaborate with providers and internal/external stakeholders to resolve authorization issues.
• Provide ongoing education on criteria and processes to staff and providers.

Skills

Critical thinking

Problem solving

Communication

Time management

Team collaboration

Education

RN licensure (AZ)

Bachelor's degree or higher

Job description

Banner Health is seeking an experienced RN in Medical Management to focus on prior authorization in a remote position. The role involves reviewing cases with clinical guidelines, collaborating with providers, and documenting activities to support cost-effective care.

The role operates Monday–Friday, AZ time, with rotating weekends. Ideal candidates hold an AZ RN license, a BSN or equivalent, and have at least five years of clinical experience.