RN Utilization Management Care Reviewer
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Job Description
Remote RN Utilization Management Care Reviewer at Banner Health determining medical appropriateness of services. Collaborating with care teams to optimize member outcomes and support safe transitions.
Responsibilities:
- Determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines
- Interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations
- Conduct inpatient reviews to determine financial responsibility and processes requests within required timelines
- Collaborate with multidisciplinary teams to promote Banner Health's Integrated model
- Adhere to UM policies and procedures.
Requirements:
- Bachelor’s degree in nursing or equivalent working knowledge
- Active, unrestricted State Registered Nursing (RN) license in good standing
- MCG certification or ability to obtain within six months of hire
- Five years of clinical nursing experience or equivalent working knowledge
- Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms
- Must be highly proficient in medical record review including EMR and paper/fax platforms.
Benefits:
- Health insurance
- 401(k) matching
- Paid time off
- Flexible working hours
- Remote work options
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