Arizona Licensed RN Medical Management

Job Summary

To support prior authorization processes, the full-time Arizona Licensed RN Medical Management will review cases, collaborate with providers, and document activities to ensure quality outcomes and cost-effective care in a remote setting.

Key responsibilities

• Manage health plan consumer/beneficiaries across the healthcare continuum to achieve optimal clinical and operational outcomes
• Provide pre-service determinations, concurrent reviews, and case management functions while ensuring quality service and documentation
• Collaborate with internal and external stakeholders to assist with issues related to prior authorization and utilization management

Required qualifications

• Registered Nurse (R.N.) licensure in the state of Arizona
• Bachelor's degree or equivalent experience
• Five years of clinical experience, with knowledge of care management and utilization management
• Ability to work flexible hours and participate in rotating call schedules
• Strong critical thinking and problem-solving skills