Remote RN - Prior Authorization & Care Management

Banner Health; Northern (KY); Hybrid; USD 48,000 - 81,000; Full time

Job summary

Banner Health is seeking an RN for Medical Management focused on prior authorization. This remote, desk-based role involves reviewing cases using clinical guidelines, collaborating with providers, and documenting activities to support cost-effective, quality care.

Ideal candidates have prior authorization or utilization management experience and familiarity with CareWebQI/InterQual. This is a full-time role with Arizona residency required.

Qualifications

• Requires RN licensure in the state of practice with license details.
• Bachelor’s degree or equivalent experience.
• Typically five years of clinical experience.
• Working knowledge of care management, acute/home care environments.
• Ability to work in an interdisciplinary team and manage time effectively.
• Flexibility to work rotating after-hours calls.

Responsibilities

• Provide pre-service determinations and utilization management functions.
• Collaborate with providers and document prior authorization activities.
• Perform case management and care coordination to support quality outcomes.
• Review cases using clinical guidelines and ensure timely documentation.
• Educate internal and external stakeholders on population health and guidelines.

Skills

Critical thinking

Communication skills

Time management

Teamwork

Care management knowledge

Flexibility in hours

Education

RN licensure

Bachelor’s degree or equivalent experience

Tools

CareWebQI/InterQual

Job description

Banner Health is seeking an RN for Medical Management focused on prior authorization. This remote, desk-based role involves reviewing cases using clinical guidelines, collaborating with providers, and documenting activities to support cost-effective, quality care.

Ideal candidates have prior authorization or utilization management experience and familiarity with CareWebQI/InterQual. This is a full-time role with Arizona residency required.