Utilization Review RN Part-Time (Remote in Arizona)

Kingman Regional Medical Center-posted 7 months ago

Part-time • Entry Level

Remote • Kingman, AZ

Hospitals

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Now Hiring: Part-Time Remote Utilization Review Nurse (AZ Residents Only) Work From Home | Weekends | Registered Nurse (RN) Opportunity Are you a Registered Nurse (RN) looking for a flexible, part-time opportunity that allows you to work from the comfort of your home? We invite you to join our Case Management team at Kingman Regional Medical Center as a Remote Utilization Review Nurse! This is a remote position available only to residents of Arizona. Position Purpose: The Utilization Review Nurse performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. The UM Nurse has an emphasis on the review, analysis, monitoring, and operation of the patient medical care plans and works toward optimal clinical, financial, operational, and satisfaction outcomes.

Conducts medical necessity reviews for Medicare, Medicaid, self-pay, and other insured patients.
Verifies physician orders per Medicare and payer guidelines and ensures documentation reflects patient acuity accurately.
Coordinates with medical staff, Case Managers, and Insurance Specialists to facilitate clear communication with payers, ensuring timely, accurate information.
Consults with the Physician Advisor for complex cases and engages in denial management.
Documents utilization review activities in the MCG system, maintains complete records, and collaborates across teams for quality care.
Educates staff on clinical guidelines, utilization review, and payer regulations.
Assesses patient cases using nationally recognized criteria for admission and care level.
Collaborates with physicians to determine inpatient vs. observation status and performs Code 44 when necessary.
Identifies cases needing further intervention, considers appropriateness and quality, and communicates expected length of stay per Medicare guidelines.
Supports Case Managers and educates staff on CMS guidelines and documentation needs.
Protects patient rights, ensuring confidentiality and compliance with hospital policies.
Participates in committees and ongoing education, staying current with performance improvement and regulatory standards.

Must reside in Arizona to be eligible for remote work.
Graduate of an accredited nursing school.
Active Arizona or compact state RN license.
Must have 1+ years of Utilization Review experience, preferably in both clinical and managed care, and 3 years clinical experience (preferably med-surg/critical care).
Strong clinical knowledge, communication, problem-solving, and proficiency in standard office tools.
Ability to work with diverse teams and recognize quality care issues.
Excellent verbal and written communication, interpersonal skills, and ability to use standard office equipment/software.
Strong clinical skills and able to recognize quality issues, and knowledge of nationally recognized criteria used to make medical necessity determinations.
Effective problem solving, analyzing complex situations, draw conclusions and implement appropriate actions efficiently.
Ability to sit for 3-5 hours per day, stand 3-5 hours, and walk 3-5 hours.

Paid Sick Time
403b Retirement Plan with Employer Contributions
Scholarship Program for qualified individuals pursuing a first degree in healthcare related field
On-Site Daycare, exclusive to our employees' children of all ages
Employee Discounts and Employee Referral Bonus Program
Eligibility for the Public Service Loan Forgiveness program for employees with qualified student loans

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Utilization Review RN Part-Time (Remote in Arizona)

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