Yavapai Regional Medical Center

RN Utilization Review

Job ID
Care Management
Job Family
East Campus - Prescott Valley

Job Summary

The RN Utilization Review supports the vision of the Total Healing Environment and the values of respect, integrity, accountability, commitment and quality while performing criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; comply with applicable standards and regulations; and provide information and education to clinical care providers in order to achieve optimal clinical, financial, operational and patient satisfaction outcomes.

Job Qualifications

Preferred Qualifications:

  • CCM or Utilization Review/Management certification
  • Working knowledge with INTERQUAL or Milliman
  • Electronic Medical Record (EMR) experience preferred; Cerner strongly preferred

Required Qualifications:

  • Must hold a current, valid Arizona or compact RN state license
  • Two to five years utilization management/utilization review and care management experience in an acute care setting
  • Working knowledge of Medicare guidelines pertinent to inpatient hospital and ambulatory services
  • Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers
  • Basic computer literacy and proficiency in Microsoft Windows
  • Basic proficiency with MS Office, Word and Excel

*Must pass pre-employment screening

Company Overview

Yavapai Regional Medical Center is a not-for-profit, integrated healthcare provider that offers a broad range of inpatient and outpatient services. Our healing network includes two full-service acute care hospitals, primary and specialty care clinics, the YRMC Wellness Center and the YRMC Del E. Webb Outpatient Center. YRMC's unmatched continuum of care covers a 5,500 square mile service area and includes cardiac surgery, neurosurgery, a comprehensive Women's Health Pavilion and Arizona's only Patient Blood Management Program. YRMC has earned numerous awards for quality and has earned national recognition as an exceptional provider of care.

Our Mission
To provide comprehensive, high quality healthcare consistent with our communities' needs.

Our Vision
Creating a "Total Healing Environment" wherein the people of YRMC work in partnership with the patients and their families seeking peace of mind and peace of heart as well as physical cures or comfort because we understand the indivisible relationship that exists between body, mind and the human spirit.

Our Values
Respect: Behaving in a way that honors self and others.
Integrity: Being consistent and honest in word and deed.
Accountability: Following through and being answerable for one's performance.
Commitment: Demonstrating dedication to one's work, personal development, the organization, the Mission and the Vision.
Quality: Providing service excellence.


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