Utilization Review Rn

Job Description

Job Description

*MUST BE LOCAL TO ARIZONA*

A-Line Staffing is seeking a Remote 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.

Required:

• Graduate of an accredited school of nursing OR Bachelor’s degree with 2–4 years of related experience.

• Registered Nurse (RN) in Arizona

• Minimum 2 years of experience in the behavioral health field .

• Strong computer proficiency and ability to multitask.

• 3+ Years of 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:

1. Behavioral health clinical review skills.

2. Computer proficiency.

3. 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.