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 your well-being and that of your family
- Engage in meaningful work that impacts patient care and community health
- Collaborative work environment with a focus on team-based care
- Chance to make a difference in healthcare delivery and patient outcomes

What to Expect (Job Responsibilities):
- Review and monitor utilization of healthcare services to ensure high-quality, cost-effective care
- Conduct comprehensive reviews for medical necessity of admissions and ancillary services
- Facilitate the delivery of services through effective resource utilization and documentation review
- Collaborate with physicians, case managers, and payers to address documentation issues and appeals
- Maintain a system to identify admissions needing additional review and clarification

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
- Active Registered Nurse (RN) State and/or Compact State Licensure

How to Stand Out (Preferred Qualifications):
- Experience with Medicare, AHCCCS, and self-pay patient reviews
- Strong analytical skills and attention to detail in reviewing clinical documentation
- Ability to work collaboratively with multidisciplinary teams
- Knowledge of healthcare regulations and compliance standards

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