Remote RN Utilization Review Specialist - Case Management

HonorHealth; Arizona; Remote; USD 90,000 - 115,000; Full time

Job summary

HonorHealth is seeking an Utilization Review RN Specialist to review medical necessity, monitor care, and coordinate UR reviews for Medicare, AHCCCS, self-pay, and other payers, both on admission and concurrently throughout the stay.

You will collaborate with care management, physicians, payers, and records teams to ensure accurate documentation and data reporting, including chart reviews and denial appeals.

Qualifications

• 1 year UR/UM or Case Management experience required.
• 3 years RN in an acute care setting required.
• RN license (State and/or Compact State licensure) required.
• CCM certification preferred.

Responsibilities

• Reviews clinical documentation and ensures it reflects level of service and severity of illness.
• Performs initial and concurrent reviews for patients entering the care continuum.
• Interfaces with Care Management, physicians, payers to appeal denials and improve data reporting.

Skills

Utilization Review

Case Management

Clinical Documentation

Education

Associates in Nursing

Bachelors in Nursing

Job description

HonorHealth is seeking an Utilization Review RN Specialist to review medical necessity, monitor care, and coordinate UR reviews for Medicare, AHCCCS, self-pay, and other payers, both on admission and concurrently throughout the stay.

You will collaborate with care management, physicians, payers, and records teams to ensure accurate documentation and data reporting, including chart reviews and denial appeals.