Job Details

Behavioral Health Utilization Reviewer (100% Remote - Arizona)

Join a leading Medicaid managed care organization that has been serving the Arizona community for over 30 years. We combine the resources of a national healthcare network with deep-rooted local engagement to provide high-quality care to our members.

We are seeking licensed Behavioral Health professionals or RNs to ensure our members receive cost-effective, evidence-based care through expert utilization management.

Quick Facts

• Pay Rate: $ 39.28/hr

• Location: 100% Remote (Must reside in Arizona )

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

• Licensure: Must hold an active, unrestricted Arizona BH License (LCSW, LPC, or LMFT) OR an RN with a compact license and a behavioral health focus.

Primary Duties & Responsibilities

• Clinical Review: Apply medical necessity criteria, policies, and professional judgment to render coverage and discharge planning decisions.

• Care Coordination: Communicate with healthcare providers and internal teams to facilitate timely authorizations and continuity of care.

• Concurrent Review: Monitor ongoing inpatient or outpatient treatment to ensure services align with evidence-based standards.

• Crisis Support: Provide urgent clinical interventions, including triage and crisis support when required.

• Optimization: Identify opportunities to reduce unnecessary services while promoting high-quality, member-centered care.

• Documentation: Maintain audit-ready clinical reports and monitor key performance indicators (KPIs).

Top Required Skills

1. BH Utilization Management: Experience in initial/concurrent reviews and discharge planning.

2. Clinical Assessment: Strong critical thinking skills to evaluate records and balance quality with resource utilization.

3. Communication: Ability to coordinate effectively across stakeholders and provide provider education on UM processes.

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.