Arizona Licensed RN Medical Management

Job Summary

To support health plan consumers in achieving optimal care outcomes, the full-time Arizona Licensed RN Medical Management will manage pre-service requests, perform case management, and coordinate care remotely while adhering to federal and state regulations.

Key responsibilities

• Manages health plan consumer/beneficiaries across the healthcare continuum to ensure optimal clinical and operational outcomes
• Provides pre-service determinations and performs concurrent reviews within the Medical Management framework
• Collaborates with internal and external stakeholders to assist with prior authorization and utilization management issues

Required qualifications

• Active Registered Nurse (R.N.) licensure in Arizona
• Bachelor's degree or equivalent experience
• Five years of clinical experience in care management or related fields
• Knowledge of care management, acute care, and resource/utilization management
• Ability to work flexible hours and participate in rotating call duties