Prior Authorization Nurse

Job Details 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 Base pay range (provided by IMCS Group): $39.00/hr - $42.00/hr Direct message the job poster from IMCS Group

Overview

Dedicated Manager Leading Service Delivery Success In US Recruitment | Enhancing Processes & Fostering Relationships Job Duties / Responsibilities

• 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.
• Review and evaluate member treatment for mental health and substance use before, during, and after services to ensure services are medically appropriate; review prior and continued stay requests for mental health and substance use outpatient services.
• Analyze member data to improve quality and appropriate utilization of services; educate providers and outpatient teams regarding the BH UM process; interact with BH health care providers to discuss the appropriate level of care; engage with Medical Directors, BH Case Managers, and other departments to assist with coordination of care and other needed services.

Must Haves

• 2 years in the behavioral health field; utilization review experience is a plus
• Behavioral health clinical review skills
• Computer proficiency
• Ability to multi-task and stay organized
• Expertise reviewing BH medical charts and treatment plans; experience in BH utilization review

Education / Certifications

• Graduate of an accredited school of nursing or a BA degree with 2-4 years of related experience
• LCSW, LMHC, LPC, LMFT, LMHP, or RN (state OR or compact state licensure)

Seniority level

• Mid-Senior level

Employment type

• Contract

Job function

• Health Care Provider

Industries

• Staffing and Recruiting

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