Remote RN Utilization Review Specialist - Per Diem

HonorHealth; Arizona; Remote; USD 80,000 - 100,000; Full time

Job summary

HonorHealth is seeking an RN Utilization Review Specialist to review and monitor health care service utilization, ensuring appropriate levels of care and medical necessity across admissions and payer types. You will coordinate medical necessity reviews for Medicare, AHCCCS, self-pay, and other payers from admission through discharge.

You will work with the Care Management team to ensure documentation supports services, collaborate with physicians, payers, and care teams to address denials and

Qualifications

• Associate degree in nursing is required or
• Bachelor's degree in nursing preferred
• 1 year UR/UM or Case Management experience required
• 3 years RN in an acute care setting required

Responsibilities

• Reviews clinical documentation and ensures level of care reflects services rendered and severity of illness.
• Performs initial and concurrent reviews for admission and ongoing care.
• Collaborates with physicians, case managers, payers and others to appeal denials and address contract guidelines.
• Interacts with Care Management to provide quality outcome data and supports data reporting.
• Initiates chart reviews and rounds to ensure continuity of utilization reviews.

Skills

Utilization Review

RN experience

Collaboration

Education

Associates in Nursing

Bachelors in Nursing

Job description

HonorHealth is seeking an RN Utilization Review Specialist to review and monitor health care service utilization, ensuring appropriate levels of care and medical necessity across admissions and payer types. You will coordinate medical necessity reviews for Medicare, AHCCCS, self-pay, and other payers from admission through discharge.

You will work with the Care Management team to ensure documentation supports services, collaborate with physicians, payers, and care teams to address denials and