Risevoic
Registered Nurse (RN)
Company : Catholic Health Initiatives
Location : Scottsdale, AZ, 85258
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
In Scottsdale, RNs involved in utilization review balance clinical care with regulatory compliance, requiring strong critical thinking to assess patient hospitalization needs. This role ensures optimal resource use while maintaining quality care, which can intensify daily responsibilities compared to typical bedside nursing.
Certifications like Certified Case Manager (CCM) and Accredited Case Manager (ACM-RN) are highly valued in Arizona, especially in Scottsdale's healthcare market. These credentials demonstrate expertise in patient care coordination and utilization review, enhancing RN competitiveness for advanced nursing positions.
Within the Phoenix region, RNs can progress from clinical roles to nurse manager or director positions, often leveraging experience in utilization review or case management. Hospitals like those in Scottsdale emphasize leadership development, encouraging RNs to pursue advanced degrees and certifications for upward mobility.
Catholic Health Initiatives embeds humankindness into daily nursing care, emphasizing compassionate service for underserved communities. Registered Nurses at St. Joseph’s Hospital engage in patient-centered practices aligned with these values, fostering a supportive environment beyond clinical duties.
At Catholic Health Initiatives, RNs benefit from a legacy of care dating back over a century, with access to premier quaternary care institutes. This environment offers diverse clinical challenges and collaborative interdisciplinary teams, setting it apart from other regional healthcare employers.
Scottsdale requires RNs to hold an Arizona or compact nursing license, facilitating mobility within state borders. Familiarity with CMS and AHCCCS regulations is crucial here, reflecting Arizona’s healthcare framework and payer requirements that influence nursing practice.
Registered Nurses in Scottsdale working in utilization review or case management generally earn between $75,000 and $95,000 annually. Factors influencing pay include experience, certifications like CCM, and the employing organization's size, with Catholic Health Initiatives offering competitive compensation.
Scottsdale’s nursing market is moderately competitive, with steady demand for experienced RNs skilled in acute care and utilization review. Trends show increasing preference for candidates with case management certifications and experience in regulatory compliance to meet evolving healthcare standards.
RNs must showcase proficiency in criteria-based utilization review, effective communication with multidisciplinary teams, and regulatory knowledge including CMS and AHCCCS. Critical thinking to determine appropriate patient status and collaboration with physician reviewers are also essential competencies.
St. Joseph’s Hospital’s status as a top quaternary care center means RNs encounter complex cases requiring high-level clinical judgment. The institution’s commitment to research and education enriches nursing roles, fostering continuous learning and involvement in advanced patient care coordination.