Arizona Licensed RN Medical Management

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