Remote Medical Prior Authorization & Utilization Specialist

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

Benefits offered by this job

10 paid holidays

Paid vacation and sick time

Paid parental leave

Retirement plan with ASRS

Public Service Loan Forgiveness

Remote work option

Job summary

Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, seeks a Medical Prior Authorization Consultant in the Division of Fee for Service Management. They monitor, evaluate, and approve or deny payment for medical and behavioral services across prospective, concurrent, and retrospective reviews.

The role collaborates with providers and AHCCCS staff on care coordination, utilization review, and coverage criteria.

Qualifications

• Must maintain a current Arizona medical license (RN or higher) or Arizona Behavioral Health license.
• 3+ years of relevant healthcare experience.
• Travel may be required for state business and driving may be involved.

Responsibilities

• Monitor, evaluate, and approve or deny payment of medical/behavioral services.
• Collaborate with providers, Tribal and AHCCCS staff on care coordination and utilization review.
• Educate and assist FFS Providers and Tribal staff to improve compliance with AHCCCS requirements.

Skills

Problem solving

Public relations

Organization

Computer skills

Analytical ability

Interpersonal skills

Education

Arizona medical license (RN or higher)

Tools

EHR systems

Job description

Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, seeks a Medical Prior Authorization Consultant in the Division of Fee for Service Management. They monitor, evaluate, and approve or deny payment for medical and behavioral services across prospective, concurrent, and retrospective reviews.

The role collaborates with providers and AHCCCS staff on care coordination, utilization review, and coverage criteria.