Remote Utilization Review RN (AZ Residents Only)

About the role

The Utilization Review RN provides remote medical necessity reviews for patients admitted to inpatient or observation status, ensuring accurate documentation and appropriate reimbursement for a hospital system. This position is open exclusively to Arizona‑licensed registered nurses.

Key responsibilities

• Conduct initial and ongoing medical necessity reviews for admissions, evaluating physician orders against Medicare and payer guidelines.
• Communicate with physicians, case managers, and insurance specialists to clarify orders, resolve documentation issues, and prevent denials.
• Enter and maintain utilization review data in the hospital’s information systems, supporting audit and reporting requirements.
• Collaborate with the Denials Manager and RAC team to identify trends and participate in the denials management process.

Required profile

• Graduate of an accredited nursing program (BSN preferred).
• Minimum three years of clinical RN experience in a hospital setting and at least one year of utilization review or two years of case‑management experience.
• Current, valid Arizona (or compact) RN license.

Required skills

• Proficiency with Milliman or InterQual utilization review criteria.
• Experience using electronic medical record (EMR) and utilization review data systems.