Position at a Glance:
- Compensation: Competitive Salary ($24-$34/hour)
- Company: Workwarp (Serving Arizona through Consideration Care, an Aeetna-CVS Health partnership)
- Location: Remote (Arizona-based)
- Position: Remote Clinical Review Specialist
- Start Date: Immediate openings available
Job Summary:
Join our team as a Remote Clinical Review Specialist! In this full-time, work-from-home role, you will play a vital role in reviewing prior authorization requests for physical and social well-being services. You'll leverage your clinical expertise to ensure appropriate utilization of care and support individuals with disabilities and special needs.
Responsibilities:
- Conduct prior authorization reviews for physical and social well-being services.
- Utilize clinical knowledge to coordinate, document, and communicate all aspects of the utilization/benefit management program.
- Apply critical thinking and evidence-based care models to determine the appropriate level of service for individuals with disabilities and special needs.
- Communicate with providers regarding prior authorization questions and make informed decisions to support patient care.
- Gather clinical information and apply clinical guidelines to facilitate authorization, denial, or discharge decisions.
- Assess and collaborate with providers to ensure appropriate utilization of services.
- Identify opportunities to improve the quality and efficiency of clinical review processes.
- Comfortable with prolonged sitting, talking, and listening.
Qualifications:
- Minimum of 5 years of clinical experience as a Registered Nurse (RN).
- Valid and unrestricted RN license in Arizona.
- Ability to maintain a consistent work schedule within the Arizona (MST) time zone.
- Willingness to attend occasional in-state team gatherings.
- Reliable transportation is required; mileage will be reimbursed.
- Strong critical thinking and interpersonal skills.
- Long-term commitment to nursing is required.
About Us:
Consideration Care is a Medicaid-directed care program serving Arizona residents since 1985. We partner with healthcare providers to ensure individuals with disabilities and special needs receive the appropriate care and support. As part of the Aeetna-CVS Health network, we benefit from a robust support system while maintaining a community-focused approach.
We Encourage You to Apply! Even if you feel you're not a perfect match, we'd still love to hear from you. We are looking for great people to join our friendly team.
Apply Now
Apply Now