RN Utilization Review Specialist

Kingman Healthcare; Kingman (AZ); Remote; USD 78,000 - 92,000; Full time

Job summary

Kingman Healthcare Incorporated (KHI) seeks an experienced Utilization Review Nurse to support case management in Arizona. You will conduct medical necessity reviews and coordinate inpatient vs observation status, collaborating with physicians, payers, and the case management team to ensure compliant, cost-effective care.

Ideal candidates hold a BSN (MSN preferred), have 3+ years RN hospital experience, and UR or CM exposure.

Qualifications

• Graduate from an accredited school of nursing.
• RN with Arizona or compact state license.
• Minimum 3 years clinical RN experience in hospital settings.
• UR experience or 2 years case management as an RN.
• Knowledge of Milliman or InterQual criteria preferred.

Responsibilities

• Conduct and coordinate medical necessity reviews for admitted or observation status.
• Verify orders and ensure documentation reflects illness severity and acuity.
• Collaborate with physicians, case managers, and payers for timely information.
• Enter utilization review data accurately and maintain records.
• Communicate with staff about status changes and denials management.
• Educate team on guidelines, payer regulations, and CMS updates.

Skills

Clinical assessment

InterQual criteria knowledge

Communication skills

Problem-solving

Discharge planning

Multidisciplinary collaboration

Education

Bachelor of Science in Nursing

Master of Science in Nursing

Tools

EMR documentation

Job description

Kingman Healthcare Incorporated (KHI) seeks an experienced Utilization Review Nurse to support case management in Arizona. You will conduct medical necessity reviews and coordinate inpatient vs observation status, collaborating with physicians, payers, and the case management team to ensure compliant, cost-effective care.

Ideal candidates hold a BSN (MSN preferred), have 3+ years RN hospital experience, and UR or CM exposure.