Nurse

• Review and monitor utilization of healthcare services to maintain high-quality, cost-effective care
• Conduct comprehensive medical-necessity reviews for extended stays, outpatient observation, inpatient stays, and ancillary services
• Coordinate and conduct reviews for Medicare, AHCCCS, self-pay, and other payers upon admission and concurrently throughout admission
• Review clinical documentation and facilitate modifications to accurately reflect level of service and severity of illness
• Perform initial and concurrent reviews for patients entering the healthcare continuum
• Facilitate delivery of services through effective utilization of available resources
• Perform medical record reviews as required by payers
• Interface with the Care Management team regarding quality outcome measurements
• Collaborate with physicians, case managers, payers, and others to appeal denials and trended issues
• Work with medical records, finance, and physician groups to improve documentation and data reporting
• Initiate chart reviews, conduct follow-up reviews, and round on patients to ensure continuity of utilization-review reviews
• Maintain systems identifying admissions by diagnosis, DRG classifications, and other categories
• Notify physicians and appropriate staff about documentation issues requiring clarification
• Determine qualifications for hospital-level care using established criteria
• Perform other duties as assigned

Utilization Review RN evaluating medical necessity for HonorHealth’s Arizona nonprofit healthcare system

Registered Nurse – Utilization Review, Per Diem

Utilization Review RN evaluating medical necessity and documentation for HonorHealth, an Arizona nonprofit healthcare system. Coordinating payer reviews, appeals, and hospital-level-of-care determinations.

• Function as a lead nurse on shift and develop clinic assignments and duties for nursing staff
• Support the ITR Nurse Manager and Supervisor with clinic compliance initiatives
• Drive operational improvement and change management initiatives within the clinics
• Mentor and provide guidance to ITR nursing staff
• Orient new staff on job responsibilities, policies, procedures, and equipment use
• Create and maintain an inclusive, positive employee culture
• Analyze ITR needs and make recommendations to nursing leadership
• Address and minimize pre-booking bottlenecks at the ITR
• Review nursing documentation and Electronic Health Record queues to ensure tasks are completed
• Ensure availability of equipment and supplies for daily clinic operations
• Communicate with nursing staff and direct workflows
• Ensure medically necessary care is completed before patients move from ITR to assigned housing

Charge Nurse leading clinical operations for Maricopa County correctional healthcare

Nurse House Supervisor

Charge Nurse leading clinical operations for Maricopa County Correctional Health Services. Directing nursing staff and patient care at the Intake, Transfer, and Release facility.

• Provide comprehensive emergent and critical care to critically ill or injured patients before and during transport
• Stabilize chronically and acutely ill or injured patients for hospital transport
• Provide care in ground ambulances and other transport modalities when air transport is not possible
• Independently assess patients, administer medications and perform procedures
• Collaborate with health team members and healthcare teams at other facilities to ensure continuity of care
• Communicate with hospitals, EMS, police and fire departments, patients, families and external contacts
• Complete annual education requirements
• Perform advanced procedures including chest tubes, central lines, I/O placement, cricothyrotomy and intubation
• Operate assigned vehicles and provide safe, reliable and timely transport when applicable
• Develop safe transport solutions under operational constraints
• Synthesize and prioritize information from multiple sources to support patients and families

Flight RN transporting critically ill patients for Banner Health’s nonprofit hospital system

Flight Registered Nurse, RN

Flight RN providing rotor-wing critical care and emergency transport for Banner Health’s nonprofit hospital system. Stabilizing patients and performing advanced procedures across Arizona transport bases.

• Record patients' medical history and symptoms
• Help perform diagnostic tests and analyze results
• Operate medical equipment
• Administer treatments and medications
• Establish or contribute to patient care plans
• Start, maintain, and discontinue intravenous lines for fluids, medications, blood, and blood products
• Observe patients and record observations
• Consult with physicians and other healthcare clinicians
• Teach patients and families about illness or injury management, post-treatment and home care, diet, nutrition, exercise, medication, and therapy
• Provide direction to licensed practical nurses and nursing aides and delegate appropriately
• Precept new-hire staff and students
• Support competency development for staff and students
• Collect and analyze health data and develop, implement, evaluate, and revise individualized plans of care
• Initiate treatments, medications, emergency, and resuscitative measures under standing orders, policies, and procedures
• Provide family-centered nursing care addressing physical, emotional, spiritual, and social-cultural needs
• Document nursing interventions, therapeutic measures, monitoring data, and other patient-care information
• Evaluate care-plan quality and effectiveness to promote high-quality, cost-effective healthcare
• Evaluate nursing practice against professional standards, statutes, regulations, and policies
• Collaborate with multidisciplinary teams, patients, families, and healthcare providers
• Develop and evaluate evidence-based standards of care
• Participate in evidence-based research and improve nursing practice and patient outcomes
• Promote clinical knowledge, professional development, patient experience, clinical outcomes, and a healthy work environment

Registered Nurse providing Med-Surg Tele patient care for HonorHealth, a Phoenix-area nonprofit healthcare system

Registered Nurse Traveler – Med Surg, Tele

Registered Nurse providing Med-Surg Tele care for HonorHealth, a Phoenix-area nonprofit healthcare system. Assessing patients, administering treatments, coordinating care, and supporting clinical education.

• Provide and supervise direct and indirect total nursing care for identified age-specific groups
• Utilize the nursing process to assess, plan, implement, and evaluate nursing care
• Perform principal duties under the direct supervision of a preceptor during the training program
• Participate in clinical shifts, classroom learning, online modules, simulations, hands-on skills, and return demonstrations
• Complete assigned residency modules and unit- and facility-specific training
• Participate in preceptor and educator check-ins and work toward clinical growth and competency goals
• Transition to independent practice after successful completion of the training program
• Transition to the RN job description after completing the yearlong nurse resident program
• Participate in a continued learning plan once every four weeks during the first year of independent practice

Nurse Resident delivering supervised acute-care nursing at Northern Arizona Healthcare

Nurse Resident

Nurse Resident delivering supervised acute-care nursing at Northern Arizona Healthcare’s Flagstaff Medical Center. Completing clinical, classroom, and online training before transitioning to independent RN practice.

• Review complex clinical criteria-based prior authorizations electronically and/or in writing according to CVS/Caremark policies, procedures, and health plan/employer criteria
• Refer cases that do not meet clinical criteria for upper-level review when appropriate
• Manage calls, prior authorization requests, and ad hoc assignments with urgency and responsiveness
• Follow prior authorization procedures and support business quality, regulatory, and accreditation standards
• Participate in ongoing quality assurance activities, including reviewing work instructions and job aids
• Collaborate with prior authorization representatives, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members
• Complete additional prior authorization assignments delegated by leadership
• Research documentation, communicate medical services, and make prior authorization determinations using clinical and problem-solving skills
• Multitask and adapt effectively in a fast-paced changing environment
• Work sedentary shifts involving telephone communication, multiple computer programs and screens, and keyboarding
• Maintain regular and predictable attendance
• Work required overtime and weekends when business needs require

CVS Health Nurse Associate reviewing prior authorizations remotely from Arizona

Nurse Associate

CVS Health Nurse Associate reviewing clinical prior authorizations remotely from Arizona. Applying health plan criteria and collaborating with pharmacists and clinical teams.

• Aids patients in obtaining the correct level of care with the appropriate provider
• Provides advance clinical telephone support to Sutter Health patients
• Assesses patients' needs, dispositions cases, collaborates with clinic and hospital-based providers
• Assists physician partners with message management and communications within the EMR system
• Performs nursing follow-up activities.

Clinical Triage Nurse providing phone support to Sutter Health patients

Clinical Triage Nurse

Clinical Triage Nurse providing telephone clinical support to Sutter Health patients. Assessing needs and collaborating with healthcare providers for optimal patient care.

• Provide telephonic clinical assessment, health education and utilization management services across the life span
• Care coordination for patients, including prior authorization; identifying and seeking solutions for barriers to care
• Provide telephonic triage for patients seeking care with multiple complaints
• Assessment and provision of care using telecommunication devices
• Application of the nursing process in telehealth care
• Delivery of culturally sensitive, age-specific care to identified populations
• Use of clinical decision support tools
• Provide effective therapeutic communication, counsel and crisis management
• Handle multiple in bound calls and ability to complete out-bound calls
• Other duties as assigned.

Virtual RN providing telephonic clinical assessment for general care

Nurse, Virtual RN

Virtual RN providing telephonic clinical assessment and health education in a community-based setting for Westside Family Healthcare. Participate in care coordination and telehealth services for diverse patient needs.

• Conducting comprehensive pre-surgical assessments
• Coordinating with multidisciplinary teams
• Ensuring every patient is physically and emotionally prepared for their procedure
• Blending clinical judgment with exceptional communication skills
• Serving as the vital link between patients, surgeons, anesthesiologists, and care teams

Registered Nurse in Preadmission unit ensuring patient preparation for procedures

Registered Nurse, Preadmission

Registered Nurse in Preadmission unit at Banner Health preparing patients for surgeries. Conducting assessments and coordinating care with interdisciplinary teams for successful patient outcomes.

• Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
• Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
• Collaborates with healthcare partners to ensure timely review of services and care.
• Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
• Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
• Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
• Triages and prioritizes cases and other assigned duties to meet required turnaround times.
• Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
• Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
• Duties as assigned.

Utilization Management Nurse performing clinical reviews for health services.

Utilization Management Nurse

Utilization Management Nurse providing evaluations of medical necessity for healthcare services. Collaborates with healthcare partners and handles clinical documentation remotely.

• Provide one-on-one high quality, concierge style private nursing care & support to adult patients in their homes or hotel in Phoenix, AZ and surrounding cities
• Duties include hands on direct registered nursing care with clients, advocating, educating, care coordination, and more
• Focus is post-surgical, post-hospitalization, aging at home and hospice client populations
• Provides Nursing care based on the Arizona State Nurse Practice Act, The American Nurses Association Code of Ethics and the Massachusetts Nurse of the Future

Private Duty Nurse providing concierge style care in Phoenix

Private Duty Nurse, PRN Role

Private Duty Nurse providing high quality nursing care and support to adult patients in Phoenix. Role involves hands on care, advocacy, and education for various patient populations.

• Track and respond to calls for a multi-state nurse triage telephone service.
• Provide clinical assessment based on established protocols and triage patients by phone or through patient portal.
• Provide administrative support and perform clinical tasks.
• Facilitate referrals and collaborate on addressing prior authorization requests.
• Participate in Remote Patient Monitoring (RPM) initiatives.
• Screen and qualify patients for clinical trials.

Registered Nurse providing remote telephone triage support for various states

RN Telephone Triage Nurse – Compact License, IL, MA, NY, MN, DC

Registered Nurse providing remote telephone triage support. Handling clinical assessments and administrative tasks for multi-state telehealth services.

Nurse jobs in Arizona

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