Remote RN Utilization Review Specialist - Case Management

NurseRemotely; United States; Remote; USD 85,000 - 105,000; Full time

Job summary

HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines.

The ideal candidate has an RN license with 1 year UR/UM or Case Management experience and 3 years RN in acute care, with strong collaboration across disciplines and payer interfaces.

Qualifications

• RN with an associate degree is required; bachelor’s preferred.
• 1 year UR/UM or Case Management experience required.
• 3 years RN in an acute care setting required.

Responsibilities

• Review clinical documentation and modify as needed to reflect level of service and severity of illness.
• Collaborate with care teams, payers, and physicians to support medical necessity reviews.
• Conduct initial and concurrent reviews for patients entering care continuum.
• Identify admissions and notify attending staff of documentation issues needing clarification.
• Determine qualifications for hospital level of care per criteria.
• Perform other duties as assigned.

Skills

Case management

RN experience

Medical record review

Healthcare utilization review

Interdisciplinary collaboration

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

Job description

HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines.

The ideal candidate has an RN license with 1 year UR/UM or Case Management experience and 3 years RN in acute care, with strong collaboration across disciplines and payer interfaces.