A-Line Staffing Solutions
Clinical Review Nurse - Prior Authorization
A-Line Staffing Solutions, Tempe, Arizona, us, 85285
Job Title: Utilization Review Clinician / Clinical Review Nurse – Prior Authorization
Openings: 1
Location: Remote – must reside in Arizona and hold independent AZ licensure
Schedule: Monday–Friday, 8:00am–5:00pm, no overtime required
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Position Overview
A-Line Staffing is seeking a Utilization Review Clinician / Clinical Review Nurse to support the Behavioral Health Utilization Management (BH UM) team for AZCH. This position will review member treatment for mental health and substance abuse services to ensure appropriateness, compliance, and alignment with CMS final rule requirements effective January 2026.
Responsibilities
Perform utilization review of behavioral health services (prior authorization and continued stay requests). Evaluate treatment plans and medical records for mental health and substance abuse outpatient services. Ensure compliance with CMS’s 7-day turnaround requirement for medical record reviews. Collaborate with Behavioral Health providers, Case Managers, and Medical Directors to coordinate care and ensure appropriate service levels. Educate providers and outpatient teams on the Behavioral Health UM process. Analyze member data to improve service quality and utilization outcomes.
Candidate Profile Required:
Graduate of an accredited school of nursing OR Bachelor’s degree with 2–4 years of related experience. Independent licensure in Arizona: LCSW, LMHC, LPC, LMFT, LMHP, or RN. Minimum 2 years of experience in the behavioral health field. Strong computer proficiency and ability to multitask.
Preferred:
Prior utilization review experience. Expertise in reviewing behavioral health medical charts and treatment plans.
Disqualifiers:
Not independently licensed in Arizona. Not living in Arizona.
Top Skills:
Behavioral health clinical review skills. Computer proficiency. Organization and multitasking.
Why Join Us?
Fully remote position supporting Arizona behavioral health members. Opportunity to contribute to compliance with new CMS standards. Collaborative team environment with internal training and support. Chance to apply clinical expertise to improve quality and utilization of behavioral health services.
Interview & Onboarding
1-step interview via Microsoft Teams (camera required, ~30 minutes). Training provided internally following background clearance.
Perform utilization review of behavioral health services (prior authorization and continued stay requests). Evaluate treatment plans and medical records for mental health and substance abuse outpatient services. Ensure compliance with CMS’s 7-day turnaround requirement for medical record reviews. Collaborate with Behavioral Health providers, Case Managers, and Medical Directors to coordinate care and ensure appropriate service levels. Educate providers and outpatient teams on the Behavioral Health UM process. Analyze member data to improve service quality and utilization outcomes.
Candidate Profile Required:
Graduate of an accredited school of nursing OR Bachelor’s degree with 2–4 years of related experience. Independent licensure in Arizona: LCSW, LMHC, LPC, LMFT, LMHP, or RN. Minimum 2 years of experience in the behavioral health field. Strong computer proficiency and ability to multitask.
Preferred:
Prior utilization review experience. Expertise in reviewing behavioral health medical charts and treatment plans.
Disqualifiers:
Not independently licensed in Arizona. Not living in Arizona.
Top Skills:
Behavioral health clinical review skills. Computer proficiency. Organization and multitasking.
Why Join Us?
Fully remote position supporting Arizona behavioral health members. Opportunity to contribute to compliance with new CMS standards. Collaborative team environment with internal training and support. Chance to apply clinical expertise to improve quality and utilization of behavioral health services.
Interview & Onboarding
1-step interview via Microsoft Teams (camera required, ~30 minutes). Training provided internally following background clearance.