Job Summary

A healthcare and retail pharmacy company has a current position open for a Remote Utilization Management Clinical Consultant.

Must be able to:

• Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
• Apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services
• Gather clinical information and apply the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment

Must meet the following requirements for consideration:

• Ability to travel to the Phoenix office (up to 10%) with a personal vehicle
• Registered Nurse (RN) with unrestricted Arizona state license
• 3+ years of clinical practice experience
• Ability to utilize understanding of CMS and Medicaid benefits to review coverage determinations
• Ability to coordinate and communicate with providers and other parties to facilitate optimal care/treatment
• Ability to identify members who may benefit from care management programs and facilitates referral