Registered Nurse – Utilization Review, Per Diem

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🌵 Arizona – Remote

🌵 Arizona – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

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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 healthcare services to maintain high-quality, cost-effective care • Conduct comprehensive medical-necessity reviews for extended stays, outpatient observation, inpatient stays, and ancillary services • Coordinate and conduct reviews for Medicare, AHCCCS, self-pay, and other payers upon admission and concurrently throughout admission • Review clinical documentation and facilitate modifications to accurately reflect level of service and severity of illness • Perform initial and concurrent reviews for patients entering the healthcare continuum • Facilitate delivery of services through effective utilization of available resources • Perform medical record reviews as required by payers • Interface with the Care Management team regarding quality outcome measurements • Collaborate with physicians, case managers, payers, and others to appeal denials and trended issues • Work with medical records, finance, and physician groups to improve documentation and data reporting • Initiate chart reviews, conduct follow-up reviews, and round on patients to ensure continuity of utilization-review reviews • Maintain systems identifying admissions by diagnosis, DRG classifications, and other categories • Notify physicians and appropriate staff about documentation issues requiring clarification • Determine qualifications for hospital-level care using established criteria • Perform other duties as assigned

🎯 Requirements

• Associate's Degree in Nursing from an accredited NLN/CCNE institution - Required • Bachelor's Degree in Nursing from an accredited NLN/CCNE institution - Preferred • 1 year experience in UR/UM or Case Management - Required • 3 years Registered Nurse experience in an acute care setting - Required • Registered Nurse (RN) State and/or Compact State Licensure - Required • Certified Case Management (ACM) Case Management Certification - Preferred • Medical necessity and utilization review knowledge • Ability to review clinical documentation and medical records • Knowledge of Medicare, AHCCCS, self-pay, and other payer requirements • Ability to determine hospital-level-of-care qualifications using set criteria • Ability to collaborate with physicians, case managers, payers, and other stakeholders • Day-shift availability, 7:30–4:00, with team operations Monday through Sunday • Remote work after training

🏖️ Benefits

• Remote work after training • Day shift, 7:30–4:00 • PRN/per diem scheduling