This role focuses on remote clinical care review for members in Arizona, with an emphasis on assessing medical necessity and coordinating appropriate services. The clinician primarily applies nursing judgment in utilization or care review workflows, supporting safe, appropriate, and timely access to care. Day-to-day work is likely centered on documentation, case review, and collaboration with internal care teams.
Key Responsibilities
- Conduct clinical reviews to assess medical necessity and appropriateness of services
- Review member cases and supporting medical documentation
- Coordinate with internal care management and utilization review teams
- Apply nursing judgment to support care decisions and service authorization workflows
- Document review findings and maintain accurate case records
Required
- Registered Nurse (RN) licensure
- Ability to work remotely in Arizona