Employer Industry: Healthcare

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits portfolio designed to support you and your family
- Engage in meaningful work that directly impacts patient care and outcomes
- Collaborative work environment with a focus on team success
- Involvement in innovative programs and initiatives to enhance healthcare delivery

What to Expect (Job Responsibilities):
- Review clinical documentation to ensure compliance with regulations and accuracy in reflecting the level of service rendered
- Coordinate and conduct medical necessity reviews for various payers, including Medicare and AHCCCS
- Collaborate with the Care Management team and other stakeholders to address quality outcome measurements
- Initiate and conduct follow-up chart reviews, escalating issues to the Physician Advisor as necessary
- Maintain a system to monitor admissions based on specific diagnoses and notify appropriate staff of documentation issues

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 in a healthcare organization with a focus on quality care and patient outcomes
- Knowledge of payer regulations and documentation requirements
- Strong analytical and problem-solving skills
- Excellent communication and collaboration abilities

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