Utilization Review Nurse | Case Management Specialist

Kingman Regional Medical Center; Kingman, Northern (AZ, KY); Hybrid; USD 85,000 - 105,000; Full time

Job summary

Kingman Healthcare Incorporated (KHI) is seeking an experienced Utilization Review Nurse in Case Management. You will review medical necessity for inpatient and observation status, coordinate with physicians, and ensure accurate documentation for appropriate level of care.

The role requires strong clinical nursing skills, knowledge of payer criteria (Medicare/InterQual preferred), and collaboration with care teams to optimize outcomes and reimbursement.

Qualifications

• RN with current license in Arizona or compact state.
• Minimum of 3 years nursing clinical experience in hospital setting (unit-based).
• Experience with utilization review processes or case management preferred.

Responsibilities

• Coordinate medical necessity reviews for admitted/inpatient or observation status.
• Review IPOs and ensure proper orders and documentation for level of care.
• Verify physician orders and ensure documentation supports severity of illness and acuity.

Skills

Medical terminology

Communication skills

Analytical thinking

InterQual knowledge

Education

Graduate from an accredited nursing school

Job description

Kingman Healthcare Incorporated (KHI) is seeking an experienced Utilization Review Nurse in Case Management. You will review medical necessity for inpatient and observation status, coordinate with physicians, and ensure accurate documentation for appropriate level of care.

The role requires strong clinical nursing skills, knowledge of payer criteria (Medicare/InterQual preferred), and collaboration with care teams to optimize outcomes and reimbursement.