RN Utilization Review Specialist

3 weeks ago


Scottsdale, Arizona, United States HonorHealth Full time
Job Summary

HonorHealth is seeking a skilled RN Utilization Review Specialist to join our team. As a key member of our Case Management department, you will play a critical role in ensuring high-quality, cost-effective care for our patients.

Responsibilities
  • Conduct comprehensive reviews of patient records to ensure medical necessity and appropriateness of care.
  • Collaborate with physicians, case managers, and payers to resolve denials and trended issues.
  • Develop and implement systems to facilitate complete documentation for data reporting purposes.
  • Initiate chart reviews, conduct follow-up reviews, and round on patients to ensure continuity of UR reviews.
  • Determine qualifications for hospital level of care based on set criteria.
Requirements
  • Associate's Degree in Nursing from an accredited NLN/CCNE institution.
  • 3 years Registered Nurse in an acute care setting.
  • 1 year experience in UR/UM or Case Management.
  • Registered Nurse (RN) State And/Or Compact State Licensure.
About HonorHealth

HonorHealth is one of Arizona's largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. We are committed to providing high-quality care and improving the health and well-being of our communities.



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