Remote Medical Prior Authorization Consultant

State of Arizona; Phoenix (AZ); Remote; USD 64,000 - 78,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement plan

Job summary

Arizona Health Care Cost Containment System (AHCCCS) seeks a Medical Prior Authorization Consultant to monitor, evaluate, and decide on medical requests for the Fee for Service population. You will base decisions on care standards, regulations, and AHCCCS policies.

Key duties include coordinating with providers and tribal staff, reviewing utilization metrics, and educating providers on AHCCCS requirements. This role offers remote work opportunities within Arizona and requires state residency.

Qualifications

• Must maintain a current Arizona medical license (RN or higher) or Arizona Behavioral Health license and 3 years of healthcare experience.
• Experience in Prior Authorization, Utilization Management, claims review, auditing, or managed care is preferred.
• Travel may be required for State business; remote work within Arizona is possible.
• New hires must complete E-Verify as part of eligibility.

Responsibilities

• Collaborates with providers, Tribal and AHCCCS staff on care coordination and utilization review.
• Evaluates, negotiates rates, and monitors program policy compliance and reporting.
• Confers with Utilization Review Coordinators regarding concurrent review of stays and services.
• Provides education and technical assistance to FFS Providers and Tribal staff.
• Tracks focused reviews for compliance with Federal and State rules; maintains documentation.
• Creates system-generated reports and analyses for unit, division, and management.
• Participates in process improvement projects to enhance care coordination and utilization management.

Skills

Problem solving

Public relations

Organizational skills

Computer skills

Analytical ability

Interpersonal skills

Job description

Arizona Health Care Cost Containment System (AHCCCS) seeks a Medical Prior Authorization Consultant to monitor, evaluate, and decide on medical requests for the Fee for Service population. You will base decisions on care standards, regulations, and AHCCCS policies.

Key duties include coordinating with providers and tribal staff, reviewing utilization metrics, and educating providers on AHCCCS requirements. This role offers remote work opportunities within Arizona and requires state residency.