Utilization Review Nurse
4 weeks ago
Position Title: Utilization Review Nurse Location: Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods, and ongoing care to ensure adherence to Medicare and regulatory guidelines while promoting positive patient outcomes. Essential Responsibilities Review and process prior authorizations and reauthorization requests in accordance with company policy. Assess medical documentation to determine the need for continued home health services based on Medicare guidelines. Refer cases outside of established guidelines to the Utilization Review Physician Advisor. Maintain accurate and timely records of authorizations, communications, and payer interactions. Collaborate with provider staff to identify patient needs, coordinate care, and ensure appropriate resource utilization. Monitor patient progress and outcomes to support efficient, cost-effective care. Serve as a communication link and provide customer service support to payer case managers, patients, and provider teams. Submit required status and summary reports within deadlines. Participate in weekend and holiday rotation; remain available for after-hours support as needed. Review clinical documentation for compliance with CMS Chapter 7 and Milliman Care Guidelines; provide feedback to clinicians on medical necessity, homebound status, visit utilization, and discharge planning. Identify and escalate quality-of-care concerns to the Quality Assurance Committee/QPUC. Support the Utilization Review Committee/QPUC in addressing and resolving utilization-related issues. Qualifications Graduate of an accredited program in professional, practical, or vocational nursing. Current, active nursing license (RN, LPN, or LVN) in good standing with the Arizona Board of Nursing and other state boards as applicable. Minimum of two (2) years of general nursing experience in medical, surgical, or critical care. At least one (3) years of experience in utilization review/management, case management, or recent home health fieldwork. Excellent oral and written communication abilities. Proven time management skills and ability to meet deadlines. Self-directed, flexible, and able to work independently with minimal supervision. Working knowledge of home care regulations and federal requirements. Experience Familiarity with home health and community-based services. Experience in utilization or case management preferred. Knowledge of homecare, managed care, medical/nursing procedures, and community resources. NCQA and URAC experience is a plus. Proficiency with MS Office (Outlook, Word, Excel), Adobe, and multiple electronic medical record systems.
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Utilization Review Nurse
6 days ago
Phoenix, United States IntePros Full timePosition Title: Utilization Review NurseLocation: Fully RemotePosition SummaryThe Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients' needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods, and...
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Utilization Review Nurse
4 weeks ago
Phoenix, United States IntePros Full timePosition Title: Utilization Review NurseLocation: Fully RemotePosition SummaryThe Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients’ needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods,...
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Utilization Review Nurse
1 week ago
Phoenix, AZ, United States IntePros Full timePosition Title: Utilization Review NurseLocation: Fully RemotePosition SummaryThe Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients' needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods, and...
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Nurse Utilization Review
3 weeks ago
Phoenix, United States Arizona Staffing Full timeCase Management And Social Work Opportunity Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; comply with applicable standards and...
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Utilization Review Nurse
4 weeks ago
Phoenix, AZ, United States IntePros Full timePosition Title: Utilization Review Nurse Location: Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients' needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods,...
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Utilization Review Nurse
4 weeks ago
Phoenix, United States IntePros Full timePosition Title: Utilization Review NurseLocation: Fully RemotePosition SummaryThe Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients needs, ensuring efficient, cost-effective, and compliant delivery of home health care. This role monitors admissions, reauthorizations, extended certification periods, and...
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Utilization Review Nurse
1 week ago
Phoenix, AZ, United States NavitsPartners Full timeJob Title: Utilization Review Nurse (UR Nurse)Schedule: Monday - Friday | 8:00 AM - 5:00 PM Work Model: 100% Remote (Onsite visit required for equipment pickup) Employment Type: Contract Position Overview The Utilization Review Nurse is responsible for monitoring and providing clinical oversight to ensure compliance with contractual, regulatory, and...
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Utilization Review Nurse
2 weeks ago
Phoenix, AZ, United States NavitsPartners Full timeJob Title: Utilization Review Nurse (UR Nurse)Schedule: Monday - Friday | 8:00 AM - 5:00 PM Work Model: 100% Remote (Onsite visit required for equipment pickup) Employment Type: Contract Position Overview The Utilization Review Nurse is responsible for monitoring and providing clinical oversight to ensure compliance with contractual, regulatory, and...
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Utilization Review Coordinator
1 week ago
Phoenix, United States Aspire Health Center Full timePosition Summary Aspire Health is seeking an experienced Utilization Review Coordinator to support clinical operations through timely, accurate review of medical services. This remote position plays a critical role in ensuring care delivery aligns with established medical necessity criteria, payer requirements, and regulatory standards. The ideal candidate...
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Utilization Clinical Reviewer
2 weeks ago
Phoenix, Arizona, United States TriWest Healthcare Alliance Full timeProfileWe offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.Veterans, Reservists, Guardsmen and military...
