Utilization Review RN - Per Diem (Remote/Arizona)

10 John C. Lincoln Medical Center; Arizona; Hybrid; USD 80,000 - 110,000; Full time

Job summary

HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity across inpatient and outpatient settings. You will coordinate reviews for Medicare, AHCCCS, and other payers, working with the Care Management team to optimize resource use and outcomes.

The role requires RN licensure, 1 year UR/UM or case management experience, and 3 years as an RN in acute care. Associates or Bachelors in Nursing are preferred.

Qualifications

• UR/UM review and case management concept
• Collaboration with care teams, physicians and payers
• Attention to medical necessity and documentation accuracy

Responsibilities

• Review and monitor utilization of health care services for Medicare, AHCCCS, self-pay and other payers.
• Coordinate medical necessity review upon admission and concurrently throughout stay.
• Partner with Care Management to improve outcomes and data reporting.
• Initiate chart reviews, conduct follow-ups, and round on patients for UR reviews.
• Notify physicians of documentation issues and determine hospital level of care.
• Support system to develop complete documentation for data reporting purposes.

Job description

HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity across inpatient and outpatient settings. You will coordinate reviews for Medicare, AHCCCS, and other payers, working with the Care Management team to optimize resource use and outcomes.

The role requires RN licensure, 1 year UR/UM or case management experience, and 3 years as an RN in acute care. Associates or Bachelors in Nursing are preferred.