RN Utilization Review Specialist | Night Case Management

Veterans in Healthcare; Yuma (AZ); On-site; USD 61,000 - 97,000; Full time

Job summary

The Onvida Health unit at Yuma Regional Medical Center is seeking an RN Utilization Review Specialist for night shift. You will conduct prospective and concurrent medical record reviews to determine medical necessity and appropriate level of care, and support admission and continued stay decisions.

You will collaborate with physicians and care teams, ensure CMS and payer requirements are met, and help optimize reimbursement and resource utilization while maintaining clinical excellence.

Qualifications

• Associates degree and 3 years related experience in Arizona
• AZ RN License and BLS (AHA) required

Responsibilities

• Perform admission and continued stay reviews using CMS criteria to determine level of care.
• Communicate with payers to obtain authorizations and address denials.
• Ensure compliance with CMS Conditions of Participation and payer policies.
• Educate providers on documentation improvements to support medical necessity.

Skills

Case management

Utilization review

Nursing

CMS regulations

Education

Associate's degree

Job description

The Onvida Health unit at Yuma Regional Medical Center is seeking an RN Utilization Review Specialist for night shift. You will conduct prospective and concurrent medical record reviews to determine medical necessity and appropriate level of care, and support admission and continued stay decisions.

You will collaborate with physicians and care teams, ensure CMS and payer requirements are met, and help optimize reimbursement and resource utilization while maintaining clinical excellence.