Remote RN: Medical Management & Prior Authorization

Banner Health; Phoenix (AZ); On-site; USD 48,000 - 81,000; Full time

Job summary

Banner Health is seeking an RN Medical Management professional for a remote Prior Authorization role in Arizona. The position focuses on reviewing cases using clinical guidelines, performing pre-service determinations, and coordinating care with providers to support cost-effective, quality outcomes.

The ideal candidate has prior authorization or utilization management experience, is licensed as an RN in Arizona, and can work a day shift with rotating weekends from 8:00 AM to 5:00 PM AZ time.

Qualifications

• RN licensure in the state of practice.
• Bachelor's degree or equivalent experience.
• Five years of clinical experience.
• Working knowledge of care management, acute/home care environments, and resources.
• Ability to work in an interdisciplinary team and manage time effectively.
• Flexibility to work rotating calls and hours.

Responsibilities

• Manage health plan consumer/beneficiaries across the care continuum to achieve optimal outcomes.
• Provide pre-service determinations, concurrent review, and case management within Medical Management.
• Collaborate with providers and internal/external stakeholders on prior authorization and utilization management.
• Document interventions and ensure accurate medical records.
• Evaluate medical necessity and coordinate care to resolve barriers.
• Educate stakeholders on population health management and evidence-based practices.

Skills

Care management knowledge

Interdisciplinary teamwork

Effective communication

Time management

Problem-solving

Education

Bachelor's degree

Tools

CareWebQI/InterQual

Job description

Banner Health is seeking an RN Medical Management professional for a remote Prior Authorization role in Arizona. The position focuses on reviewing cases using clinical guidelines, performing pre-service determinations, and coordinating care with providers to support cost-effective, quality outcomes.

The ideal candidate has prior authorization or utilization management experience, is licensed as an RN in Arizona, and can work a day shift with rotating weekends from 8:00 AM to 5:00 PM AZ time.