Registered Nurse – Utilization Review

🕒 September 29

🌵 Arizona – Remote

🌵 Arizona – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 31%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 47 days.
• Jobs at this company usually fill in 24 days.
• Reposted once.
• No salary listed.

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HonorHealth

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2013

🏥 Healthcare

📚 Education

Healthcare • Education

HonorHealth is an integrated healthcare organization that offers hospital and outpatient medical services, primary care, urgent care, telehealth (E-Visits), and patient-facing digital tools like MyChart. The organization also operates a research institute, offers academic programs (residencies, fellowships, CME, medical student resources), maintains a foundation and volunteer/community programs, and provides patient resources such as billing, price transparency, and online appointment scheduling. HonorHealth positions itself as a community-focused health system delivering clinical care, education, and research.

📋 Description

• Review and monitor utilization of health care services to maintain high-quality, cost-effective care • Ensure appropriate levels of care through comprehensive reviews for medical necessity of extended stays, outpatient observation, inpatient stays, and ancillary services • Coordinate and conduct medical necessity reviews for Medicare, AHCCCS, self-pay, and other payers upon admission and concurrently throughout admission • Review clinical documentation and facilitate modifications to accurately reflect the level of service and severity of illness • Perform initial and concurrent reviews for patients entering the health care continuum • Facilitate delivery of services through effective utilization of available resources • Perform medical record reviews as required by payers • Provide Care Management with quality outcome measurement information • Collaborate with physicians, case managers, payers, medical records, finance, and physician groups on denials, contract guidelines, and documentation systems • Initiate chart reviews, conduct follow-up reviews, and round on patients to ensure continuity of utilization review • Maintain systems identifying admissions by diagnosis, DRG classification, or other categories • Notify physicians and staff of documentation issues requiring clarification • Determine qualifications for hospital level of care based on established criteria • Perform other duties as assigned

🎯 Requirements

• Associates in Nursing from an accredited NLN/CCNE institution Required or Bachelors in Nursing from an accredited NLN/CCNE institution Preferred • 1 year experience in UR/UM or Case Management Required • 3 years Registered Nurse in an acute care setting Required • Registered Nurse (RN) - License State And/Or Compact State Licensure Required • Certified Case Manager - Certification Certified Case Management (ACM) Case Management Certification Preferred • Seeking Applicants That Can Work at Least 8 Shifts per Month

🏖️ Benefits

• Career development opportunities • Nonprofit healthcare system employment • Per diem/PRN scheduling • Remote work arrangement

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