Risevoic
Clinical RN
Company : Catholic Health Initiatives
Location : Apache Junction, AZ, 85120
Job Type : Full Time / Part Time
Date Posted : 23 December 2025
Job Summary and Responsibilities
Under the general direction of the Director of Care Management, performs 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.
Skills needed:
Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS. Working knowledge with INTERQUAL or Milliman preferred. Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post-acute care providers.
Responsibilities:
- Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, concurrent and post discharge for appropriate status determination.
- Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
- Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
- Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
- Collaborates with facility RN Care Coordinators to ensure progression of care.
- Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.
Minimum:
- Graduate of an accredited school of nursing
- Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience
- RN: AZ or Compact License
- Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used
Preferred:
- Bachelor's Degree in Nursing (BSN) or related healthcare field
- At least five (5) years of nursing experience
- Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification
- Utilization Review experience
Hello humankindness
Located conveniently in the heart of Phoenix, Arizona, St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved.
We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute, Norton Thoracic Institute, Cancer Center at St. Joseph's, Ivy Brain Tumor Center, and St. Joseph's Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph’s is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of the hospital’s patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph’s.
U.S News & World Report routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital.
St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of Arizona's Most Admired Companies
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For the health of our community ... we are proud to be a tobacco-free campus.
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Frequently asked questions
Certifications like Certified Case Manager (CCM) or Accredited Case Manager (ACM-RN) are highly valued in Apache Junction, AZ. These credentials demonstrate expertise in utilization review and care coordination, aligning well with local hospitals’ standards, including Catholic Health Initiatives, enhancing job prospects and salary potential.
A Clinical RN typically focuses on patient care management, utilization reviews, and coordination with care teams. In contrast, clinical research nurses concentrate on conducting and monitoring clinical trials. Both require strong clinical knowledge but differ in patient interaction intensity and administrative responsibilities.
Critical thinking for utilization review, familiarity with CMS and AHCCCS regulations, and communication skills for liaising with providers and payers are essential. Additionally, proficiency in tools like InterQual or Milliman enhances effectiveness in managing patient care pathways.
Apache Junction sees steady demand for Clinical RNs due to its proximity to Phoenix's major healthcare centers like St. Joseph's Hospital. The area benefits from a blend of urban and suburban healthcare needs, making it competitive but rich with opportunities compared to more rural parts of Arizona.
Clinical RNs in Apache Junction generally earn between $70,000 and $85,000 annually, influenced by experience and certifications. Specialized skills in utilization review and case management can push compensation towards the higher end within this regional market.
Catholic Health Initiatives offers ongoing education on regulatory compliance and utilization review methodologies, fostering Clinical RNs’ growth through mentorship and access to advanced tools like InterQual. This environment sharpens analytical skills critical for effective patient care management.
Indeed, Catholic Health Initiatives in Apache Junction serves a broad demographic, including underserved communities. This diversity enriches Clinical RNs’ experience, demanding adaptability and cultural competence to deliver tailored, high-quality care.
While a Clinical RN primarily manages patient care and utilization reviews, an RN clinical specialist often focuses on developing clinical protocols, education, and quality improvement initiatives. The latter usually requires advanced certifications and deeper clinical expertise.
Starting as a Clinical RN can lead to roles in case management, clinical education, or supervisory positions. Gaining certifications like CCM and experience in utilization review at facilities near Phoenix, such as Catholic Health Initiatives, accelerates advancement opportunities.