Arizona Licensed Clinical Reviewer

Job Summary

To support a growing Medicaid managed-care health plan, the full-time Arizona Licensed Clinical Reviewer will conduct prior authorization reviews for physical and behavioral health services, utilizing clinical skills to coordinate and document care while communicating with providers and members remotely.

Key responsibilities

• Perform prior authorization reviews and ensure compliance with medical necessity criteria
• Communicate with healthcare providers and members regarding coverage determinations
• Identify opportunities for care management and promote quality healthcare service utilization

Required qualifications

• 5+ years of clinical experience as a Registered Nurse (RN)
• Active and unrestricted RN licensure in Arizona or Compact RN licensure
• Ability to work 8-hour shifts, 5 days a week, including rotating weekends and holidays
• Associate's degree in Nursing