Arizona Licensed RN Medical Management

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