Remote RN Medical Management — Prior Authorization Expert

bannerhealth; Arizona; On-site; USD 49,000 - 81,000; Full time

Job summary

Banner Health is seeking an experienced RN Medical Management professional to focus on prior authorization in a remote, day-shift position. You will review cases using clinical guidelines, collaborate with providers, and document activities to support quality outcomes and cost-effective care.

Ideal candidates will have prior authorization or utilization management experience, familiarity with CareWebQI/InterQual, and a strong clinical background.

Qualifications

• RN licensure in the state of practice with issuing state and expiration date or equivalent certification.
• Bachelor's degree or equivalent experience required.
• Five years of clinical experience typically required.
• Ability to work flexible hours and rotating call after hours.

Responsibilities

• Review pre-service determinations and utilization management using clinical guidelines.
• Collaborate with providers and support care coordination and case management.
• Document all interventions accurately in the medical record.

Skills

Critical thinking

Communication

Time management

Interdisciplinary teamwork

Education

RN licensure in state of practice

Bachelor's degree or equivalent experience

Job description

Banner Health is seeking an experienced RN Medical Management professional to focus on prior authorization in a remote, day-shift position. You will review cases using clinical guidelines, collaborate with providers, and document activities to support quality outcomes and cost-effective care.

Ideal candidates will have prior authorization or utilization management experience, familiarity with CareWebQI/InterQual, and a strong clinical background.