Remote RN: Medical Management & Prior Authorization

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

Job summary

Banner Health is seeking an RN for Medical Management Services to support pre-service determinations, care coordination, and utilization management in a remote role requiring AZ residency.

The position involves researching plans, coordinating with providers and members, and documenting activities to ensure appropriate care and cost efficiency. Hours are Monday–Friday 8 AM–5 PM with Saturday rotations.

Qualifications

• Requires RN licensure in the state of practice.
• Bachelor’s degree or equivalent experience.
• Minimum five years of clinical experience.
• Working knowledge of care management and utilization management.
• Ability to work in an interdisciplinary team and communicate effectively.

Responsibilities

• Manages health plan consumer/beneficiaries across the care continuum.
• Provides pre-service determinations, concurrent review, and case management.
• Collaborates with providers, payers, and members on prior authorization and utilization management.
• Documents interventions accurately and timely in the medical record.
• Provides ongoing education to internal and external stakeholders on population health management.

Skills

RN licensure

Bachelor's degree

5+ years clinical exp

Care management knowledge

Communication skills

Education

Bachelor's degree

Job description

Banner Health is seeking an RN for Medical Management Services to support pre-service determinations, care coordination, and utilization management in a remote role requiring AZ residency.

The position involves researching plans, coordinating with providers and members, and documenting activities to ensure appropriate care and cost efficiency. Hours are Monday–Friday 8 AM–5 PM with Saturday rotations.