Arizona Licensed RN Medical Management

Job Summary

To support the Prior Authorization department, the full-time Arizona Licensed RN Medical Management will manage health plan consumer/beneficiaries' needs, perform pre-service determinations, and coordinate care while working remotely Monday through Friday from 8 AM to 5 PM, with Saturday rotations required.

Key responsibilities

• Manages health plan consumer/beneficiaries across the healthcare continuum to achieve optimal outcomes
• Provides pre-service determinations and case management functions, ensuring quality service and documentation
• Collaborates with internal and external customers to address issues related to prior authorization and utilization management

Required qualifications

• Registered Nurse (R.N.) licensure in Arizona
• Bachelor's degree or equivalent experience
• Five years of clinical experience in care management or acute care settings
• Knowledge of community resources and utilization management
• Ability to work flexible hours and participate in rotating call schedules