Arizona Licensed Utilization Review Nurse

Job Summary

To ensure healthcare efficiency and quality, the remote Arizona Licensed Utilization Review Nurse will conduct meticulous reviews of medical records, authorize services, and prepare cases for physician review while collaborating with UM teams to monitor patient care for appropriateness, quality, and cost-effectiveness.

Key responsibilities

• Conduct admission and continued stay reviews according to Care Coordination Utilization Review guidelines to determine the appropriateness of hospitalization
• Ensure compliance with utilization review principles, hospital policies, and external regulatory agencies
• Communicate timely with physicians, payers, and Care Coordinators regarding review outcomes and collaborate to ensure progression of care

Required qualifications

• Graduate of an accredited school of nursing
• Minimum two (2) years of acute hospital clinical experience or a Master's degree in Case Management or Nursing in lieu of 1 year of experience
• Active RN license in Arizona or Compact License
• Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used
• Knowledge of federal, state, and managed care rules and regulations including CMS and AHCCCS