Arizona Licensed RN Care Reviewer
Job Summary
As a Remote Arizona Licensed RN Care Reviewer, the full-time salaried position will manage the medical appropriateness of requested services for Medicare Advantage and AHCCCS members, ensuring optimal care transitions and collaborating with interdisciplinary teams while working Monday through Friday, 8 am to 5 pm.
Key responsibilities
- Assess inpatient services to ensure optimum outcomes and compliance with regulations
- Analyze clinical services against evidence-based guidelines to determine medical necessity
- Collaborate with multidisciplinary teams to promote integrated care models
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
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