[Hiring] RN Medical Management @Banner Health

Role Description

As a RN Medical Management, you will focus on prior authorization. In this desk-based role, you will:

• Review cases using clinical guidelines
• Collaborate with providers
• Document prior auth activities to support quality outcomes and cost-effective care
• Use Microsoft Outlook, Teams, and Word frequently
• Participate in meetings and conduct independent case reviews

Ideal candidates have:

• Experience in prior authorization or utilization management
• Experience using CareWebQI/InterQual
• A strong clinical background
• Comfort working in a remote environment

This is a REMOTE POSITION Monday-Friday 8:00AM-5:00PM AZ TIME with rotating weekends every 8th Saturday. Candidates must be licensed and reside in the state of Arizona to be considered for this position.

Qualifications

• Registered Nurse (R.N.) licensure in the state of practice
• Bachelor’s degree or equivalent experience
• Five years of clinical experience
• Working knowledge of care management, acute care and/or home care environments
• Community resources and resource/utilization management
• Critical thinking skills and problem-solving abilities
• Effective communication skills and time management skills
• Ability to work effectively in an interdisciplinary team format
• Flexibility to work rotating call after hours

Requirements

• Proficiency in care management
• Ability to manage health plan consumer/beneficiaries across the healthcare continuum
• Provide pre-service determinations, concurrent review, and case management functions
• Collaborate with internal and external customers
• Document patient information accurately and timely
• Evaluate medical necessity and appropriateness of care
• Provide ongoing education to stakeholders
• Identify and refer requests for services to the appropriate Medical Director
• Maintain understanding of each plan and applicable criteria

Benefits

• Estimated Pay Range: $35.43 - $59.05 / hour
• Commitment to pay equity and transparency
• Comprehensive total rewards package

Company Description

Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.