Arizona Licensed Preservice Review Nurse

Job Summary

To support a cross-functional Integrated Care Team, the remote Arizona Licensed Preservice Review Nurse will manage healthcare service reviews across outpatient and inpatient settings, collaborating with clinical peers and Medical Directors while ensuring compliance with clinical criteria and operational procedures.

Key responsibilities

• Perform initial and ongoing reviews for Prior Authorization, Inpatient Care Management, Discharge Care Management, and Post-Acute Care Management, applying clinical criteria for approvals
• Collaborate with Medical Directors and clinical peers to facilitate clinical decision-making and referrals
• Maintain compliance with Federal, State, and accreditation organizations while participating in team meetings and educational discussions

Required qualifications

• Current, unrestricted RN license in the state of residency
• 3+ years of RN experience
• Proficient computer skills including Microsoft Office Suite
• Demonstrated ability to work independently
• Willingness or ability to work weekends