Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits portfolio for full-time and part-time team members
- Chance to make a positive impact on patient care and community health
- Supportive and collaborative work environment
- Engaging training and development programs to enhance skills

What to Expect (Job Responsibilities):
- Review and monitor utilization of healthcare services to maintain high-quality, cost-effective care
- Conduct medical necessity reviews for various payers upon admission and throughout the stay
- Facilitate effective communication with physicians, case managers, and payers regarding patient care
- Initiate and conduct follow-up chart reviews to ensure continuity of utilization review processes
- Identify and notify appropriate staff of documentation issues requiring clarification

What is Required (Qualifications):
- Associate's Degree in Nursing from an accredited NLN/CCNE institution
- Minimum of 3 years of experience as a Registered Nurse in an acute care setting
- At least 1 year of experience in Utilization Review (UR) or Utilization Management (UM) or Case Management
- Current Registered Nurse (RN) State and/or Compact State Licensure

How to Stand Out (Preferred Qualifications):
- Experience with Medicare, AHCCCS, and self-pay reimbursement processes
- Familiarity with quality outcome measurements and documentation compliance
- Strong analytical skills for medical record reviews and data reporting

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