Arizona Licensed RN Care Reviewer

Job Summary

To support optimal care for Medicare Advantage and AHCCCS members, the full-time salaried Arizona Licensed RN Care Reviewer will conduct remote utilization management reviews, ensuring medical necessity and collaborating with interdisciplinary teams while working Monday to Friday, 8 am to 5 pm.

Key responsibilities

• Assess inpatient services to ensure compliance with regulations and optimize outcomes
• Analyze clinical services against evidence-based guidelines to determine medical appropriateness
• Collaborate with multidisciplinary teams to promote integrated care models and manage discharge planning

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 medical record review and computer usage, including Microsoft Suite
• MCG certification or ability to obtain within six months of hire