Utilization Management Registered Nurse (RN)
As a Utilization Management RN, you will be responsible for performing health care utilization management, prior authorization, concurrent hospital review and care coordination (specialized course of treatment and regular care monitoring) for children with qualifying chronic health/medical conditions in foster care throughout the State of Arizona.
- Gather and analyze documentation from various entities that can include health plans, behavioral health, providers, protective agencies and other involved parties.
- Review medical evaluations, member files, protective agency reports and provider records.
- Analyze incidents that indicate abuse, neglect, training and/or systemic issues within the Division or associated providers.
- Conduct trending to determine success of interventions; make recommendations for continuous improvement.
- Prepare and present cases to the Peer Review Committee.
- Conduct Root Cause Analyses to determine facts/cause of negative outcomes.
- Participate in annual audits and develops/revises policy and procedures.
- Day shift positions.
- Must have an active AZ RN license.
- Must be able to pass a 7 year background check.
Please call Thomas Fitzpatrick at 602-788-5890 or email at Thomas@apnusa.com to learn more and apply.
To stay up-to-date on the latest job openings and industry news, please connect with us on LinkedIn and Facebook!