RN Utilization Review Coordinator

As a Valleywise Health Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. Our team includes social workers, psychiatric and medical providers, nurses, behavioral health technicians, mental health workers, health unit coordinators, chaplains, and recreational therapists. Working collaboratively with the interdisciplinary team fosters a positive experience for members, their families, and coworkers.

We provide psychiatric services for children, adolescents, and adults of all ages. Services are provided at one of our three inpatient facilities (Maryvale, Phoenix, and Mesa). Over 90% of our adult patient population are hospitalized for court-ordered evaluation, which dictates a collaborative relationship with the court system.

You work under the direction of the Director of Inpatient Behavioral Health Programs and the Manager, Care Coordinator for Behavioral Health Services. You are responsible for determining the appropriateness of hospital admissions and medical necessity for continued stay, assuring medical documentation accurately reflects the severity of illness and acuity of the patient. This requires proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system. The RN Utilization Review Coordinator is responsible for assuring the appropriate use of resources and facilitating the patient's progression through the continuum of care in a timely and cost-effective manner. This position works with managed care plans, third-party payers, the business office, and the interdisciplinary team to ensure authorization for reimbursement at the appropriate level is confirmed to ensure payment of expected reimbursement.

Hourly Pay Range: $36.94 - $54.49

Qualifications
Education:

• Prefer a Bachelor's Degree in Nursing.

Experience:

• Must have at least three (3) years of recent acute clinical RN hospital experience, preferably in Case Management and/or Utilization Management.

Specialized Training:

• Trained in Epic, InterQual, Midas, and internally used software programs is strongly preferred.

Certification/Licensure:

• Must possess a current, valid Arizona RN licensure and be in good standing with the AZ Board of Nursing.
• Prefer specialty certification in utilization or case management to be obtained within 30 months of hire.
• Behavioral Health Departments: Pursuant to Arizona Administrative Code R9-10-306 CHAPTER 10 of the Dept. of Health Services, personnel must be at least 21 years of age, or at least 18 years of age and licensed or certified under ARS Title 32 and providing services within the personnel member's scope of practice.

Knowledge, Skills, and Abilities:

• Must have working knowledge of case management, hospital, community resources, and resource/utilization management.
• The position requires excellent communication, clinical skills, and professional rapport with physicians.
• Requires extensive knowledge of evidence-based clinical guidelines, best practice, workup, treatment, prognosis, and hospital procedures.
• Critical thinking ability is essential.
• Strong critical care skills, understanding of medical documentation and pathophysiology.
• Knowledge of acute care criteria sets and state and federal reimbursement programs.
• Requires the ability to read, write, and speak effectively in English.