RN Medical Management

About This Opportunity

Our talent team is representing a confidential healthcare organization seeking a Registered Nurse for a Medical Management role focused on prior authorization and utilization review. This is a fully remote position based in Arizona, operating Monday through Friday, 8:00 AM to 5:00 PM Arizona time, with rotating coverage every 8th Saturday.

In this desk-based clinical role, you will review cases using established clinical guidelines, collaborate with healthcare providers on pre-service authorization requests, and document all prior authorization activities to support quality patient outcomes and cost-effective care delivery. You'll work independently while being part of a larger care coordination team.

Responsibilities

• Review and process medical pre-service authorization requests within required timeframes using clinical decision-support tools
• Conduct concurrent reviews and case management activities across the healthcare continuum
• Evaluate medical necessity and appropriateness of requested services using evidence-based criteria such as MCG and InterQual guidelines
• Document all clinical reviews, interventions, and patient-related activities accurately and timely in the medical record system
• Collaborate with internal and external stakeholders including providers, physician offices, and care teams
• Identify cases requiring physician clinical peer review and escalate appropriately to medical directors
• Participate in departmental call rotation for holidays and after-hours coverage as needed
• Provide education to stakeholders on population health management, evidence-based practices, and medical management processes
• Work daily with Microsoft Outlook, Teams, and Word for case management and collaboration
• Maintain thorough knowledge of plan benefits, coverage criteria, and applicable federal and state regulations

What We're Looking For

Required:

• Active Registered Nurse (RN) license in the state of Arizona
• Must reside in Arizona
• Bachelor's degree or equivalent experience
• Five years of clinical nursing experience
• Working knowledge of care management, acute care, or home care environments
• Experience with utilization management and community healthcare resources
• Strong critical thinking and problem-solving abilities
• Effective written and verbal communication skills
• Excellent time management skills and ability to work independently
• Comfortable working in a remote environment with daily technology use
• Ability to work flexible hours including rotating weekend coverage

Preferred:

• Prior authorization or utilization management experience
• Experience using CareWebQI/InterQual or similar clinical decision-support systems
• Certifications such as Certified Case Manager (CCM), MCG Certification, RN-BC Case Manager, or Certification in Managed Care Nursing (CMCN)
• Knowledge of health plan operations and managed care environments

How We Work With You

When you apply through Get A Job.ai, one of our experienced healthcare recruiters will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration. Throughout the interview process, we'll provide guidance and support. Please do not contact the client directly—all communication should go through our recruitment team to ensure the best outcome for your candidacy.

Pay

Pay information will be discussed during the screening process based on your experience and qualifications.

Equal Employment Opportunity: Get A Job.ai is committed to creating an inclusive environment. We welcome applications from candidates of all backgrounds and provide equal employment opportunities regardless of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected characteristic.