Clinical - Clinical Review Nurse - Prior Authorization - J00927

Location : 100% Remote from Arizona (must be independently licensed and living in AZ)

Shift : Standard hours (8-5), M-F, no OT required Assignment Duration (in months) 5 Months, Feb 2026 is end of contract

Position Purpose : Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Typical Day in the Role : UM will evaluate member's treatment for mental health and substance abuse before, during, and after services to ensure services are medically appropriate and review prior and continued stay requests for mental health and substance abuse outpatient services.

They will analyze member data to improve quality and appropriate utilization of services, will educate providers and outpatient teams regarding the BH UM process, will interact with BH health care providers to discuss the appropriate level of care and engage with Medical Directors, BH Case Managers, and other department to assist with coordination of care and other needed services.

Must Haves : should have at least 2 years in the behavioral health field; it would be a bonus if they also had some experience in utilization review

Disqualifiers : not independently licensed in AZ, not living in AZ

Additional qualities to look for : expertise reviewing BH medical charts, treatment plans, any experience in BH utilization review.

Candidate Requirements Education / Certification Required : graduate of an accredited school of nursing or a BA degree and 2-4 years of related experience Licensure Required : LCSW, LMHC, LPC, LMFT, LMHP, or RN (state OR compact state licensure)