Care Review Clinician (RN) Remote (AZ)

JOB DESCRIPTION This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience. Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties •...