Arizona Licensed RN Care Reviewer

Job Summary

Working remotely full-time, the Arizona Licensed RN Utilization Management Care Reviewer will evaluate patient care, conduct reviews, and identify issues affecting service delivery while collaborating with medical teams to ensure quality care and compliance with regulations.

Key responsibilities

• Assess inpatient services for optimal outcomes and compliance with state and federal guidelines
• Analyze clinical services against evidence-based guidelines and determine medical appropriateness of requested services
• Collaborate with multidisciplinary teams and refer cases to Medical Directors as needed

Required qualifications

• Bachelor's degree in nursing or equivalent working knowledge
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Five years of clinical nursing experience or equivalent working knowledge
• Proficiency in computer usage, Microsoft Suite, and medical record review
• MCG certification or ability to obtain within six months of hire