Remote Utilization Review RN | Case Management

HonorHealth; United States; Remote; USD 75,000 - 110,000; Full time

Job summary

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring appropriate level of care and data reporting accuracy.

Responsibilities include chart reviews, collaboration with care management and physicians, and identifying documentation gaps to support timely, cost-effective care.

Qualifications

• 1 year experience in UR/UM or Case Management is required.
• 3 years RN in an acute care setting is required.
• Active RN license is required.

Responsibilities

• Review and monitor utilization of health care services for medical necessity.
• Coordinate medical necessity reviews for Medicare, AHCCCS, self-pay and other payers.
• Perform initial and concurrent reviews for patients.
• Collaborate with physicians, case managers, payers and others to appeal denials.
• Identify documentation issues and ensure accurate reflection of services.

Skills

UR/UM experience

Case management

Interdisciplinary collaboration

Education

Bachelor of Science in Nursing

Associate Degree in Nursing

RN Licensure

Job description

HonorHealth is seeking an experienced Utilization Review RN Specialist for a remote-capable role serving the greater Phoenix area. The position focuses on reviewing medical necessity and coordinating reviews for diverse payers, ensuring appropriate level of care and data reporting accuracy.

Responsibilities include chart reviews, collaboration with care management and physicians, and identifying documentation gaps to support timely, cost-effective care.