**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!
**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!