RN Utilization Review Specialist — Remote After Training

HonorHealth; Arizona; On-site; USD 85,000 - 105,000; Full time

Job summary

HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role ensures medical necessity across Medicare, AHCCCS, and other payers, both on admission and concurrently.

The position requires an RN license (compact allowed), 1 year UR/UM or Case Management experience, and a strong collaboration with physicians and care teams. Remote work is available after training.

Qualifications

• 1 year experience in UR/UM or Case Management - Required
• 3 years RN in an acute care setting - Required
• RN licensure in State or Compact state - Required
• ACM Case Management Certification - Preferred

Responsibilities

• Reviews clinical documentation and ensures alignment with level of care and regulations.
• Performs initial and concurrent reviews for patients entering the care continuum.
• Coordinates with Care Management, payers, and physicians to address denials and documentation needs.
• Monitors medical necessity reviews for Medicare and other payers during admission.
• Facilitates data reporting and maintains continuity of UR reviews with the team.
• Identifies admissions requiring clarification and notifies relevant clinicians.

Skills

Case Management

Utilization Review

Interdisciplinary Collaboration

Communication Skills

Education

Bachelor's Degree in Nursing (preferred)

Associate's Degree in Nursing (required)

Job description

HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role ensures medical necessity across Medicare, AHCCCS, and other payers, both on admission and concurrently.

The position requires an RN license (compact allowed), 1 year UR/UM or Case Management experience, and a strong collaboration with physicians and care teams. Remote work is available after training.