Prior Authorization Clinical Reviewer

Mercy Care, a Medicaid managed-care plan administered by Aetna (a CVS Health company), is hiring a Prior Authorization Clinical Reviewer to support members across Arizona. The role focuses on prior authorization review of physical and behavioral health services for Medicaid members, including families, seniors, and individuals with developmental or cognitive disabilities.

Day-to-day work includes gathering clinical information, applying medical necessity criteria, policies, and clinical judgment to render coverage determinations, and documenting decisions across the continuum of care. You'll take provider calls about prior auth questions and call members to communicate determinations. You'll also identify members who may benefit from care management programs and refer them appropriately, while spotting opportunities to improve quality and benefit utilization.

Schedule is 8-hour shifts, 5 days per week, on Arizona time, with some rotating weekends and holidays. The role is sedentary.

Requirements: 5+ years of clinical RN experience and active unrestricted Arizona RN license or Compact RN license. ADN required. Preferred: prior UM experience, combined medical and behavioral health background, acute-care experience, strong critical thinking and written communication, and ability to work independently.

Pay range: $26.01–$74.78/hour, plus eligibility for a CVS Health bonus or short-term incentive program.