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RN Utilization Management Care Reviewer
Banner HealthRemote RN Utilization Management Care Reviewer at Banner Health determining medical appropriateness of services. Collaborating with care teams to optimize member outcomes and support safe transitions.
Posted 7/28/2026full-timeRemote • Arizona • 🇺🇸 United StatesMid-LevelSenior💰 $37 - $62 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical nursing, medical record review, and utilization management, with a strong ability to collaborate with multidisciplinary teams and communicate effectively with providers and members. Proficient in navigating electronic medical records and various platforms to ensure timely and accurate service determinations.
Highest-signal resume keywords
Registered Nursing (RN) LicenseClinical Nursing ExperienceMCG CertificationMedical Record ReviewUtilization Management
ATS Keywords
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Hard Skills
Clinical Information ReviewEvidenced-Based GuidelinesInpatient ReviewsFinancial Responsibility AssessmentComputer ProficiencyTyping SkillsMicrosoft Suite ProficiencyEMR NavigationPaper/Fax Platforms
Soft Skills
Effective CommunicationCollaborationInterpersonal Skills
Certifications & Qualifications
MCG Certification
Industry Keywords
Utilization Management PoliciesIntegrated Care ModelClinical Guidelines
About the role
Key responsibilities & impact- Determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines
- Interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations
- Conduct inpatient reviews to determine financial responsibility and processes requests within required timelines
- Collaborate with multidisciplinary teams to promote Banner Health's Integrated model
- Adhere to UM policies and procedures.
Requirements
What you’ll need- Bachelor’s degree in nursing or equivalent working knowledge
- Active, unrestricted State Registered Nursing (RN) license in good standing
- MCG certification or ability to obtain within six months of hire
- Five years of clinical nursing experience or equivalent working knowledge
- Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms
- Must be highly proficient in medical record review including EMR and paper/fax platforms.
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Paid time off
- Flexible working hours
- Remote work options