For Employers

HonorHealth

Registered Nurse - Utilization Review Per Diem

Posted 2 days ago
2-5 years experience
Apply Now

Please mention DailyRemote when applying

?
Resume Match Score

See how much of this job your resume covers, and what’s missing.

Want a recruiter to go through it line by line?

Get professional review

Create a cover letter for this job

Upload your resume and we draft a letter for this exact role, tailored to what it asks for.

  • Tailored to this role
  • Based on your resume
  • Fully editable
AI Summary

The Utilization Review RN Specialist monitors healthcare services to ensure medical necessity and cost-effective care. They perform concurrent reviews, facilitate clinical documentation, and collaborate with medical teams to manage denials and quality outcomes.

Primary City/State:

Virtual Arizona

Category:

Case Management

Shift:

Day

Department:

Case Management

Seeking Applicants That Can Work at Least 8 Shifts per Month

Great care starts with great people. (Like you.)

At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Responsibilities:

JOB SUMMARY

The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Responsible for coordinating and conducting medical necessity reviews for all Medicare, AHCCCS, Self-pay, and all other payers, upon admission and concurrently throughout the admission.

ESSENTIAL FUNCTIONS
  • Reviews clinical documentation and facilitates modifications (as needed) to ensure that documentation accurately reflects the level of service rendered and severity of illness (in compliance with government and other regulations) for all patients. Performs initial and concurrent reviews on all patients entering the health care continuum.
  • Facilitates the delivery of services to patients and families through effective utilization of available resources. Performs medical record reviews, as required by payer. Interfaces with Care Management team to provide information regarding quality outcome measurements (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended issues related to contract guidelines. Works with medical records, finance and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
  • Initiates chart reviews, conducts follow-up reviews, and rounds on patients to ensure continuity of UR reviews.
  • Maintains a system to identify admissions with specific diagnosis / DRG classifications or other categories of admissions. Notifies attending physicians and house staff or other appropriate staff of documentation issues requiring clarification.
  • Determines qualifications for hospital level of care based on set criteria.
  • Performs other duties as assigned.

EDUCATION
  • Associates in Nursing from an accredited NLN/CCNE institution Required or
  • Bachelors in Nursing from an accredited NLN/CCNE institution Preferred
EXPERIENCE
  • 1 year experience in UR/UM or Case Management Required
  • 3 years Registered Nurse in an acute care setting. Required
LICENSES AND CERTIFICATIONS
  • Registered Nurse (RN) - License State And/Or Compact State Licensure Required
  • Certified Case Manager - Certification Certified Case Management (ACM) Case Management Certification Preferred

We're all in for your career.

Automatically Apply to the Best Remote Jobs

Stop the endless job search. Our AI finds and applies to the best jobs for you.

Try it Now
Keep looking

Similar Jobs

See all Remote Healthcare jobs →

Radiologist Pet Imaging / Body Focus - Kelsey-Seybold - Remote

Full Time United States $442K - $748K per year Healthcare

Epic Analyst Home Health

Full Time United States $82210 - $123K per year Healthcare

Medical Science Liaison

Full Time United States $150K - $170K per year Healthcare

Virtual IOP Therapist - (Internal Hire)

Full Time United States Healthcare

Encore Home Infusion Nurse - Accredo

Part Time United States Healthcare

Retail Area Manager - Smart Home, Health and Wearables

Full Time United States $54550 - $86550 per year Healthcare
Apply Now

Personalize your Remote Job Search in 3 Easy Steps!

Featuring 220,052+ Jobs in Healthcare

Answer easy questions

Answer easy questions

220,052+ jobs across 15+ categories

Get your best job matches

Get your best job matches

Only hand-screened, legit jobs

Find a remote job faster

Find a remote job faster

No ads, scams, or junk

“I was the first applicant for a remote marketing position that got listed on the company website the same day I applied. Had an interview within 48 hours!”

Sarah J. — Sarah J. · Marketing Manager ★★★★★ Verified