Remote RN Utilization Review Specialist | Case Management

HonorHealth; Phoenix (AZ); Remote; USD 75,000 - 95,000; Full time

Job summary

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and others from admission onward.

You will work with the Care Management team to address documentation issues, support data reporting, and collaborate with physicians, payers, and staff to optimize care and outcomes.

Qualifications

• RN licensure in state or compact state
• ACM Case Management Certification (CCM) preferred
• 1 year UR/UM or Case Management experience preferred
• 3 years RN in acute care setting required

Responsibilities

• Reviews medical necessity and utilization for Medicare, AHCCCS, self-pay and other payers.
• Coordinates and conducts medical necessity reviews at admission and concurrently.
• Interfaces with care management, physicians, payers and others to address denials and documentation gaps.
• Initiates chart reviews and follows up to ensure accurate reflection of care.
• Supports data reporting and quality outcome measurements in UR reviews.

Skills

Case Management

Care Coordination

Interdisciplinary Collaboration

Education

Associate's in Nursing

Bachelor's in Nursing

Job description

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and others from admission onward.

You will work with the Care Management team to address documentation issues, support data reporting, and collaborate with physicians, payers, and staff to optimize care and outcomes.