RN Utilization Management Care Reviewer

🔥 1 hour ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $37 - $61 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Reviewer

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Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

📋 Description

• Determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines • Interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations • Conduct inpatient reviews to determine financial responsibility and processes requests within required timelines • Collaborate with multidisciplinary teams to promote Banner Health's Integrated model • Adhere to UM policies and procedures.

🎯 Requirements

• Bachelor’s degree in nursing or equivalent working knowledge • Active, unrestricted State Registered Nursing (RN) license in good standing • MCG certification or ability to obtain within six months of hire • Five years of clinical nursing experience or equivalent working knowledge • Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms • Must be highly proficient in medical record review including EMR and paper/fax platforms.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible working hours • Remote work options