Experienced Full Stack Prior Authorization Clinical Reviewer – Remote Work Opportunity at arenaflex

Join arenaflex, a leading healthcare organization, in a unique opportunity to work from home as a Prior Authorization Clinical Reviewer. As a key member of our team, you will play a crucial role in reviewing and authorizing medical services for our clients, ensuring that they receive the best possible care.

About arenaflex

arenaflex is a renowned healthcare organization that has been serving Arizonans since 1985. We provide access to physical and behavioral health services, as well as Medicaid-directed care, to individuals who are eligible for Medicaid. Our team is dedicated to providing high-quality care to our clients, and we are committed to making a positive impact in our community.

About the Role

As a Prior Authorization Clinical Reviewer, you will be responsible for reviewing and authorizing medical services for our clients. This will involve:

• Prior authorization review of physical and behavioral health services
• Utilization of clinical skills to determine, record, and communicate all aspects of the use/benefit management program
• Utilization of critical thinking and data on clinically sound treatment, evidence-based care, and clinical need models for appropriate use of services for individuals with disabilities and special clinical needs
• Accepting provider calls associated with prior authorization questions and making decisions for individuals to advise regarding care confirmation
• Gathering clinical information and applying appropriate clinical need guidelines/rules, techniques, framework, and clinical judgment to convey care authorization/idea/discharge planning along the continuum of care
• Use of clinical experience and skills in a helpful cycle to review and work with legitimate clinical care services/benefits for individuals
• Recognizing confirmation of individuals who could benefit from care management activities and support of the referral
• Recognizing confirmation of opportunities to promote quality adequacy of clinical care services and benefit utilization

Required Qualifications

* 5+ years of clinical experience as an RN

• Must have active and unrestricted RN licensure in the state of Arizona
• Must be willing and able to participate in in-state gatherings occasionally. Reliable transportation is required. Mileage is reimbursed per our organization's cost reimbursement system
• Preferred Qualifications:

+ Prior Utilization Management experience + Strong critical thinking and made social skills

Guidance

* Long-term affirmation in Nursing is required

About the Work Environment

As a remote worker, you will have the flexibility to work from the comfort of your own home. You will be required to work Monday through Friday, 8 am to 5 pm Arizona time, with occasional in-person office gatherings. You will have access to our state-of-the-art technology and tools, as well as a supportive team of colleagues who are dedicated to providing high-quality care to our clients.

Compensation and Benefits

* Competitive hourly rate of $24-$34 per hour

• Comprehensive benefits package, including medical, dental, and vision insurance
• 401(k) retirement plan with company match
• Paid time off and holidays
• Opportunities for professional growth and development

About the Industry

The healthcare industry is a rapidly evolving field, with new technologies and treatments emerging all the time. As a Prior Authorization Clinical Reviewer, you will have the opportunity to stay up-to-date on the latest developments in the field and to contribute to the development of new treatments and services.

USA Job Market Trends

The job market in the United States is constantly evolving, with new trends and technologies emerging all the time. Some of the current trends in the job market include:

• Remote work and hybrid models
• Technology and digital skills
• Healthcare and biotechnology
• Renewable energy and sustainability
• E-commerce and logistics
• Cybersecurity
• Health and well-being
• Skilled trades and vocational roles
• Diversity, equity, and inclusion (DEI)
• Gig economy and freelancing
• Aging workforce and succession planning
• Reskilling and upskilling

How to Apply

If you are a motivated and detail-oriented individual who is passionate about providing high-quality care to our clients, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your qualifications and experience. We look forward to hearing from you!

Apply Now

Apply Job! Apply for this job