RN Utilization Review

Utilization Review Nurse

Full compliance is required 2 weeks prior to the start date. Hospital rental property limited and based on availability. Shared contractor housing only. No pets or family allowed per hospital policy.

Tuba City Regional Healthcare does not require your RN to have an AZ state license. Tuba City Regional Health Care Corporation, a JCAHO accredited health center, provides services to a 4,400 square mile area and serves as a referral center for the western part of the Navajo and Hopi Reservations. The hospital was constructed in 1975 with a bed capacity of 73. Services provided to the community include comprehensive inpatient/outpatient emergency services, dental and ophthalmology services, orthopedics, OB/GYN, oral surgery, eye surgery and urological procedures. Approximately 49% of the surgeries performed are out patient/ambulatory surgical procedures. Learn more about our organization. The Tuba City Regional Health Care Corporation is located in Northwestern Arizona on the land known as the Colorado Plateau. This semi-desert landscape varies in elevation from 4,400 in the Little Colorado River Valley to nearly 7,000 feet at Preston Mesa. The unique community of Tuba City offers a culturally rich environment. The Native American tribes located and served here are the Navajo, Hopi, and Southern Paiute. This mixture along with Anglo, Hispanic, and African American employees of the hospital and school systems make a pleasantly diverse community. The staff of medical providers includes surgeons, general medical officers, internal medicine, psychiatrists, pediatricians, family practice physicians, obstetricians, ENT specialists, orthopedic surgeons, and urologists. Dental staff includes general dentists, endodontists, oral and maxillofacial surgeons, pediatric dentists, dental assistants and hygienists. The nursing staff includes registered nurses, licensed practical nurses, nursing assistants, community health nurses, nurse practitioners, nurse midwives, CRNA, and community health medics.

Position Summary

The Utilization Review (UR) Nurse ensures that patients receive appropriate care by verifying medical necessity, confirming the correct patient status, and monitoring the ongoing need for services while working to reduce unnecessary length of stay and prevent delays; they support accurate clinical documentation for proper reimbursement, coordinate with providers and the care team on discharge planning and transitions, manage resource use to control costs, communicate with payers to prevent denials, and ensure compliance with CMS and Joint Commission requirements while contributing to reporting and quality improvement efforts. They also serve as a key liaison between clinical care, finance, and regulatory requirements, helping align patient care with both quality standards and reimbursement rules. Ultimately, their role has a direct impact on patient outcomes, hospital efficiency, and the organization’s financial performance.

Necessary Qualifications

Education:

Bachelor’s Degree in Nursing

License/Certification:

A valid, current, full and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States

Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association (AHA) throughout employment

Experience:

Three (3) years of clinical nursing experience performing direct patient care with at least 2 years in an Inpatient setting on a medical-surgical unit, PACU, or higher acuity Inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care) {clinical experience qualification may be determined by hiring manager/director.}

Demonstrate knowledge of case management, purchased referred care and utilization review processes.

Demonstrate knowledge of electronic health record systems.