Remote Utilization Management RN – Arizona with CME

Naphcare, Inc.; Phoenix (AZ); Remoto; USD 85.000 - 105.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, dental & vision insurance

401K and Roth with company match

Tuition Assistance

Paid time off

Continuing education/CMEs

Descrizione del lavoro

NaphCare is hiring an experienced Utilization Management Registered Nurse for a Remote role based with an Arizona team. The RN will oversee quality assurance, utilization review, and clinical chart assessments while collaborating with physicians to determine medical necessity.

Applicants should hold an Arizona RN license with a BSN or ADN, have 3+ years in acute care and 2 years in utilization review, and possess CPR certification. Some travel may be required, and benefits are comprehensive.

Competenze

• Current and unrestricted RN license in Arizona
• Minimum 3 years’ acute care experience and 2 years in utilization review/case management
• CPR certification

Mansioni

• Develop, implement, and administer quality assurance and utilization review processes
• Monitor and report on the quality of medical care
• Perform utilization and concurrent review of patient cases
• Conduct clinical chart assessments
• Gather information to assess and expedite care needs
• Determine need for intervention and discuss with physicians
• Review medical necessity of services and refer to Medical Director as needed
• Audit medical records to determine medical necessity
• Apply nationally recognized criteria to determine medical necessity

Conoscenze

Communication skills

Interpersonal skills

Attention to detail

Decision making

Formazione

BSN/ADN

Descrizione del lavoro

NaphCare is hiring an experienced Utilization Management Registered Nurse for a Remote role based with an Arizona team. The RN will oversee quality assurance, utilization review, and clinical chart assessments while collaborating with physicians to determine medical necessity.

Applicants should hold an Arizona RN license with a BSN or ADN, have 3+ years in acute care and 2 years in utilization review, and possess CPR certification. Some travel may be required, and benefits are comprehensive.