Arizona Licensed Utilization Review RN

Job Summary

As a remote Arizona Licensed Utilization Review RN, the successful candidate will manage admission and continued stay reviews, ensuring compliance with utilization review guidelines and regulatory standards while collaborating with healthcare teams to optimize patient care.

Key responsibilities

• Conduct admission and continued stay reviews to determine the appropriateness of hospitalization based on established criteria
• 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 for care progression

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 one year of experience
• Active RN license in Arizona or Compact License
• Ability to pass annual Inter-rater reliability test for Utilization Review products used
• Knowledge of federal, state, and managed care rules and regulations including CMS and AHCCCS