Prior Authorization Nurse

Job Title: Prior Authorization Nurse - Behavioral Health Duration: 05 months Contract (Potential to extend) Start/End Dates: 10/6/2025 - 2/28/2026 Location: Remote-AZ Shift Type: Standard hours (8-5), M-F, no OT required Job Duties: • Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. • Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. • UM will evaluate member's treatment for mental health and substance abuse before, during, and after services to ensure services are medically appropriate and review prior and continued stay requests for mental health and substance abuse outpatient services. • They will analyze member data to improve quality and appropriate utilization of services, will educate providers and outpatient teams regarding the BH UM process, will interact with BH health care providers to discuss the appropriate level of care and engage with Medical Directors, BH Case Managers, and other department to assist with coordination of care and other needed services. Must haves: • 2 years in the behavioral health field; it would be a bonus if they also had some experience in utilization review • Behavioral health clinical review skills • Computer proficiency • Ability to multi-task and remain organized • Expertise reviewing BH medical charts, treatment plans, any experience in BH utilization review Education/Certification Required: • Graduate of an accredited school of nursing or a BA degree and 2-4 years of related experience • LCSW, LMHC, LPC, LMFT, LMHP, or RN (state OR compact state licensure) Apply tot his job Apply To this Job