Phoenix, AZ · Remote
$37.14 - $61.90/hr
As a Remote RN Utilization Management Care Reviewer , you'll play a critical role in ensuring our ... Through BPN, known nationally as an innovative leader in new health care models, insurance plans ...
New
Phoenix, AZ · Remote
$37.14 - $61.90/hr
As a Remote RN Utilization Management Care Reviewer , you'll play a critical role in ensuring our ... Through BPN, known nationally as an innovative leader in new health care models, insurance plans ...
New
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Detroit, MI · Remote
$35 - $39/hr
Job Title: RN Case Manager Location: 100% Remote Duration: 12+ months License Required: Active & unrestricted Michigan RN license The RN Case Manager serves as the primary point of contact for ...
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Detroit, MI · Remote
$35 - $39/hr
Job Title: RN Case Manager Location: 100% Remote Duration: 12+ months License Required: Active & unrestricted Michigan RN license The RN Case Manager serves as the primary point of contact for ...
Austin, TX · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Austin, TX · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Raleigh, NC · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Raleigh, NC · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Phoenix, AZ · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Phoenix, AZ · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Topeka, KS · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Topeka, KS · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Scottsdale, AZ · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Scottsdale, AZ · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Overland Park, KS · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Overland Park, KS · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Topeka, KS · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Topeka, KS · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Phoenix, AZ · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Phoenix, AZ · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Louisville, KY · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Louisville, KY · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Overland Park, KS · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Overland Park, KS · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Hartford, CT · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Hartford, CT · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Danbury, CT · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Danbury, CT · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Hartford, CT · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Hartford, CT · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Columbia, MO · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Columbia, MO · Remote
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
NY · On-site +1
$61 - $63/hr
Current NYS RN license * Experience in case management, care coordination, or similar clinical ... Experience with telephonic care management or remote patient monitoring. * Familiarity with EHR ...
NY · On-site +1
$61 - $63/hr
Current NYS RN license * Experience in case management, care coordination, or similar clinical ... Experience with telephonic care management or remote patient monitoring. * Familiarity with EHR ...
Scottsdale, AZ · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
Scottsdale, AZ · On-site +1
$50K/yr
... patient's insurance payer to determine coverage benefits, anticipated out-of-pocket costs ... Remote work eligibility is subject to all work from home criteria met and based on business need.
$7.45 - $13.33
0% of jobs
$13.33 - $19.21
0% of jobs
$19.21 - $25.09
4% of jobs
$25.09 - $30.97
18% of jobs
$31.74 is the 25th percentile. Wages below this are outliers.
$30.97 - $36.84
20% of jobs
The median wage is $39.26 / hr.
$36.84 - $42.72
18% of jobs
$48.01 is the 75th percentile. Wages above this are outliers.
$42.72 - $48.60
16% of jobs
$48.60 - $54.48
10% of jobs
$54.48 - $60.36
6% of jobs
$60.36 - $66.24
4% of jobs
$66.24 - $72.12
3% of jobs
$7
$42
$72
| Aspect | Remote Rn Insurance | Remote Rn Case Manager |
|---|---|---|
| Certifications | RN license, insurance knowledge | RN license, case management certification |
| Work Environment | Insurance companies, telehealth | Healthcare facilities, telehealth |
| Employer & Industry | Insurance providers, telehealth companies | Hospitals, insurance companies, healthcare agencies |
Remote Rn Insurance focuses on assessing insurance claims and policy coverage, while Remote Rn Case Managers coordinate patient care plans. Both roles require RN licensure and involve telehealth work, but their primary responsibilities and employer settings differ.
$37.14 - $61.90/hr
Full-time
Posted 2 days ago
New
7.5
Based on 758 frontline employees who took The Breakroom Quiz
230th of 890 rated healthcare providers
Department Name:
Utilization MgmtWork Shift:
WeekendJob Category:
Clinical CareNursing careers are better at Banner Health. We’ve built smarter processes to help nurses focus on what really matters. If you want to make a difference in people’s lives - this could be the opportunity you’ve been waiting for.
As a Remote RN Utilization Management Care Reviewer, you’ll play a critical role in ensuring our Medicare Advantage and AHCCCS members receive the right care at the right time while supporting safe, successful transitions after hospitalization. Collaborating with post-acute facilities and interdisciplinary care teams, you’ll apply your clinical expertise to review medical necessity, optimize length of stay, and help improve member outcomes. If you have a passion for utilization management, care coordination, or case management—and experience with MCG or InterQual is a plus—we’d love to hear from you!
This is a remote, salaried opportunity. CANDIDATES MUST RESIDE IN THE STATE OF ARIZONA. The schedule is as follows: Monday-Friday 8am-5pm, no weekends, and major holidays off,
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, within the Utilization Management Department, will determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines. This position will interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations. In addition to pre-service, admission, and concurrent review determinations, this position will be responsible for managing length of stay, discharge planning, resources, and identification of potential quality of care or safety concerns.
CORE FUNCTIONS
1. Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines.
2. Analyzes clinical services from members or providers against evidence-based guidelines.
3. Identifies appropriate benefits, eligibility, and expected length of stay for requested services, treatments, and/or procedures.
4. Conducts inpatient reviews to determine financial responsibility. May also perform authorization reviews and/or related duties as needed. Processes requests within required timelines.
5. Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. Makes appropriate referrals to other clinical programs.
6. Collaborates with multidisciplinary teams to promote Banner Health's Integrated model.
7. Adheres to UM policies and procedures.
MINIMUM QUALIFICATIONS
Bachelor’s degree in nursing or equivalent working knowledge.
Active, unrestricted State Registered Nursing (RN) license in good standing. MCG certification or ability to obtain within six months of hire.
Five years of clinical nursing experience or equivalent working knowledge.
Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms. Must be highly proficient in medical record review including EMR and paper/fax platforms.
PREFERRED QUALIFICATIONS
Two to three years of Utilization Management experience using MCG, CMS, and clinical criteria. MSN preferred. Case Management Certification (CCM or RN-BC or CMCN). Utilization Management Certification. Certified Professional in Healthcare Quality Certification (CPHQ). Experience with Medicare Advantage, ACOs, Commercial, Dual Eligible, AHCCCS, and/or ALTCS. Experience with URAC and NCQA accreditation process. Experience using Medical Management software platforms.
Additional related education and/or experience preferred.
Estimated Pay Range:
$37.14 - $61.90 / 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.EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
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