Job Details

Remote Behavioral Health Utilization Management RN

Location: Remote (Must reside in Arizona)

Compensation: $39.28 per hour

Schedule: Monday - Friday, 8:00 AM - 5:00 PM AZ Time (Occasional holiday/weekend rotation)
The Role

We are seeking a Registered Nurse (RN) with deep Behavioral Health (BH) expertise to join our Utilization Management team. In this fully remote role, you will leverage your clinical judgment to ensure members receive the right care at the right time. You will be the bridge between clinical necessity and quality outcomes, conducting high-level reviews within a supportive, sedentary desk-based environment.
Primary Duties & Responsibilities

• Clinical Review: Apply medical necessity criteria, clinical guidelines, and professional judgment to render coverage and discharge planning decisions.
• Data Analysis: Review medical records to ensure services align with evidence-based standards and quality benchmarks.
• Coordination: Act as a primary liaison between healthcare providers and internal teams to facilitate timely authorizations.
• Concurrent Review: Monitor ongoing inpatient or outpatient treatment to support continuity of care.
• Crisis Support: Provide urgent clinical interventions, including triage and crisis support, when necessary.
• Resource Optimization: Identify opportunities to promote cost-effective, high-quality care and reduce unnecessary services.
• Documentation: Prepare detailed clinical reports to track outcomes and key performance indicators.

Candidate Requirements

• Licensure: * Active, unencumbered RN License (Compact/Multistate) with a specific focus in Behavioral Health.
  
  • Note: We will also consider candidates with active AZ LCSW, LPC, or LMFT licenses.
• Residency: Must currently reside in Arizona. While the role is remote, licenses must be active in AZ.
• Technical Skills: Familiarity with medical necessity criteria such as InterQual, MCG, ASAM, or LOCUS.
• Workspace: A private, quiet home office and high-speed internet are required for confidential review work.

Top Skills We're Looking For

1. BH Utilization Management: Expertise in initial, concurrent, and discharge planning reviews.
2. Clinical Assessment: Strong critical thinking skills to balance quality of care with member-centered needs.
3. Communication: The ability to coordinate effectively across multiple stakeholders with precise documentation and organizational skills.

Pay Details: $39.28 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.