Responsibilities
- Coordinates, documents, and communicates clinical aspects of utilization and benefit management programs using professional expertise.
- Applies clinical judgment, evidence-based guidelines, and knowledge of appropriate treatment standards to assess medical necessity and service utilization.
- Provides expert guidance to internal and external stakeholders in managing utilization and benefit coordination processes.
- Collects patient clinical data and applies established criteria, policies, and professional judgment to determine coverage, recommendations, or discharge planning.
- Uses clinical background to support collaborative evaluation and access to appropriate healthcare services and benefits.
- Engages with healthcare providers and related parties to coordinate effective patient care and treatment pathways.
- Recognizes patients who could benefit from care management or post-discharge support and initiates appropriate referrals.
- Identifies ways to improve the quality and efficiency of healthcare service delivery and benefit use.
Work Arrangement
100% remote
Other
- No weekend or holiday work required.
- Must hold a current Arizona RN license or a multi-state RN license that includes Arizona authorization.
- Occasional travel may be needed for team events or meetings.
- Position requires a dedicated, distraction-free workspace at home.
- Employees must have reliable childcare or dependent care arrangements; caregiving during work hours is not allowed.
