Arizona Licensed Utilization Review Nurse

Job Summary

Working remotely, the Arizona Licensed Utilization Review Nurse will manage the review of medical records, authorize services, and ensure compliance with utilization review guidelines while collaborating with healthcare teams to optimize patient care and resource utilization.

Key responsibilities

• Conduct admission and continued stay reviews to determine the appropriateness of hospitalizations based on established criteria
• Ensure compliance with utilization review principles, hospital policies, and regulatory agency guidelines
• Communicate effectively with physicians, payers, and Care Coordinators regarding review outcomes and patient status

Required qualifications

• Graduate of an accredited school of nursing
• Minimum two years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of one year of experience
• Active RN license in Arizona or Compact License
• Ability to pass annual Inter-rater reliability test for Utilization Review products
• Preferred: Bachelor's Degree in Nursing (BSN) or related healthcare field