Employer Industry: Nonprofit Healthcare System

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Diverse benefits portfolio designed to support you and your family
- Chance to make a meaningful impact on patient care and community health
- Collaborative work environment with a focus on high-quality care
- Engage in professional development through robust training programs

What to Expect (Job Responsibilities):
- Review and monitor healthcare services to ensure cost-effective, high-quality care
- Conduct medical necessity reviews for various payers upon admission and throughout stays
- Facilitate modifications to clinical documentation to reflect appropriate service levels
- Collaborate with care management teams and medical staff to address documentation issues
- Maintain a system to identify specific admissions and notify staff of necessary clarifications

What is Required (Qualifications):
- Associate's Degree in Nursing from an accredited NLN/CCNE institution
- Minimum of 3 years as a Registered Nurse in an acute care setting
- At least 1 year of experience in Utilization Review (UR), 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 medical necessity reviews
- Familiarity with quality outcome measurements and documentation compliance
- Strong communication skills for collaboration with healthcare teams

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