Remote Optum Utilization Review Jobs in Arizona (NOW HIRING)

Department Name:

Maternal Child Health

Work Shift:

Day

Job Category:

Clinical Care

Better Than Ever for Nurses. When we make things better than ever for nurses at Banner Health, we make things better than ever for all of us. This means investing in the holistic health and happiness of our nurses-through better pay, better benefits, better opportunities and a better community.

Join Banner University Family Care's Maternal Child Health team as aPediatric RN, Case Manager, where you'll provide telephonic complex case management and make a meaningful difference in the lives of children and their families. In this role, you'll partner with members, caregivers, providers, and community resources to coordinate care, address barriers, and support the management of complex medical needs. Through assessment, advocacy, and care planning, you'll help families navigate the healthcare system and access the right services at the right time.

As a trusted clinical resource and advocate, you'll facilitate seamless transitions across the continuum of care, ensuring members receive high-quality, evidence-based, and family-centered support. If you're passionate about improving pediatric health outcomes, building strong relationships with families, and collaborating with interdisciplinary teams to deliver whole-person care, you'll find a rewarding opportunity to create lasting impact while helping children achieve their best possible health and quality of life.

The RN, Case Manager will be onsite for training at Banner Corporate Mesa or Banner Corporate Tucson, a minimum of three months. After completing training, it is a remote position with a work schedule of Monday - Friday 8am - 5pm. Candidates must live in the state of AZ to be considered.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life.

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.

POSITION SUMMARY
This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care.
CORE FUNCTIONS
1. Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
3. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
4. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues.
5. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
7. May supervise other staff.
8. Has freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are entity based with no budgetary responsibility. Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.
MINIMUM QUALIFICATIONS

Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care.
Requires current Registered Nurse (R.N.) license in state worked. For assignments in an acute care setting, Basic Life Support (BLS) certification is also required.
Requires a proficiency level typically achieved with 3-5 years clinical experience. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format. For assignments in an acute care setting, must be able to work flexible hours and take rotating call after hours. Banner Registry and Travel positions require a minimum of one year experience in an acute care hospital and/or home care setting. Experience must include working in an acute care and/or home care setting within the past 12 months as a Case Manager in the specialty area.
PREFERRED QUALIFICATIONS

Certification for CCM (Certified Case Manager) preferred.
Additional related education and/or experience preferred.

Estimated Pay Range:

$35.43 - $59.05 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

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