Registered Nurse – Utilization Review, Per Diem

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Evaluate and oversee the utilization of health care services to ensure the delivery of high-quality, cost-efficient care.

• Verify the appropriate level of care through detailed medical-necessity reviews for extended stays, outpatient observation, inpatient admissions, and ancillary services.

• Organize and execute medical-necessity reviews for Medicare, AHCCCS, self-pay, and other payers during admission and continuously throughout the patient's stay.

• Assess clinical documentation and facilitate adjustments to accurately depict the level of service and the severity of illness.

• Conduct initial and ongoing reviews for patients entering the health care system.

• Enhance service delivery by effectively utilizing available resources.

• Carry out medical record reviews as mandated by payers.

• Supply Care Management with quality-outcome data.

• Collaborate with physicians, case managers, payers, medical records, finance departments, and physician groups regarding denials, contract stipulations, documentation, and data reporting.

• Initiate chart reviews, perform follow-up assessments, and conduct rounds on patients for the continuity of utilization review processes.

• Identify admissions with specific diagnoses, DRG classifications, or other relevant categories.

• Inform physicians and staff about documentation discrepancies that need clarification.

• Assess qualifications for hospital-level care based on established criteria.

• Execute additional tasks as assigned.

⛳️ Requirements

• Looking for candidates who can commit to at least 8 shifts per month.

• An Associate's degree in Nursing from an accredited NLN/CCNE institution is required, while a Bachelor's degree in Nursing from an accredited NLN/CCNE institution is preferred.

• A minimum of 1 year of experience in Utilization Review (UR)/Utilization Management (UM) or Case Management is required.

• At least 3 years of experience as a Registered Nurse in an acute care environment is mandatory.

• A Registered Nurse (RN) license in the state and/or compact state licensure is required.

• Certification as a Case Manager (ACM) is preferred.

🏝️ Benefits

• Per diem employment.

• Day shift schedule.

• Opportunities for career development.