Behavioral Health Utilization Review Specialist (Remote)

State of Arizona; United States; Remote; USD 64,000 - 78,000; Full time

Benefits offered by this job

10 paid holidays

Vacation and sick time

Parental leave

Retirement pension

Insurance plan

Public service loan forgiveness

Transit subsidy

Learning opportunities

Job summary

The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee for Service population, based on standards of care and relevant regulations.

Key duties include collaborating with providers and AHCCCS staff, reviewing policies, and supporting education for providers and tribal staff.

Qualifications

• Understanding of health care delivery systems and coordination
• Knowledge of medical/behavioral practice standards and care delivery
• Familiarity with AHCCCS, ALTCS, Medicaid and Medicare regulations

Responsibilities

• Collaborates with providers and AHCCCS staff on care coordination and utilization review.
• Evaluates, negotiates actions, monitors policy compliance and reporting.
• Confers with UR Coordinators on concurrent reviews of length of stay.
• Provides education and technical assistance to FFS Providers and Tribal staff.
• Tracks and maintains documentation files related to utilization management.
• Participates in process improvements and special projects to improve efficiency of care coordination.

Skills

Problem solving

Public relations

Organizational skills

Intermediate computer skills

Analytical ability

Interpersonal skills

Education

Arizona medical license (RN or higher)

Job description

The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee for Service population, based on standards of care and relevant regulations.

Key duties include collaborating with providers and AHCCCS staff, reviewing policies, and supporting education for providers and tribal staff.