**Experienced Full Stack Prior Authorization Clinical Reviewer – Web & Cloud Application Development**

Join arenaflex, a leading healthcare organization, in a dynamic and rewarding role as an Experienced Full Stack Prior Authorization Clinical Reviewer. As a key member of our team, you will play a crucial role in reviewing and processing prior authorization requests for physical and behavioral health services. With a strong focus on clinical expertise and customer service, you will work closely with healthcare providers, patients, and internal stakeholders to ensure seamless and efficient care management. **About arenaflex** arenaflex is a CVS Health company, dedicated to improving the lives of millions of people through innovative healthcare solutions. With a rich history dating back to 1985, we have been serving Arizonans with Medicaid-directed care services, providing access to physical and behavioral health benefits. Our team is passionate about delivering exceptional care and making a positive impact on our community. **Job Summary** As an Experienced Full Stack Prior Authorization Clinical Reviewer, you will be responsible for reviewing and processing prior authorization requests for physical and behavioral health services. You will utilize your clinical expertise and knowledge of healthcare regulations to make informed decisions, ensuring that patients receive the necessary care and services. Your strong communication and interpersonal skills will enable you to effectively collaborate with healthcare providers, patients, and internal stakeholders. **Key Responsibilities** * Review and process prior authorization requests for physical and behavioral health services, ensuring compliance with regulatory requirements and arenaflex policies * Utilize clinical expertise and knowledge of healthcare regulations to make informed decisions regarding prior authorization requests * Collaborate with healthcare providers, patients, and internal stakeholders to ensure seamless and efficient care management * Develop and maintain strong relationships with healthcare providers and patients, ensuring high levels of satisfaction and engagement * Stay up-to-date with changing healthcare regulations, policies, and procedures, ensuring compliance and adherence * Participate in quality improvement initiatives, identifying areas for improvement and implementing changes to enhance care management processes * Work collaboratively with cross-functional teams, including clinical, operational, and administrative departments **Essential Qualifications** * 5+ years of clinical experience as a Registered Nurse (RN) * Active and unrestricted RN licensure in the state of Arizona * Strong knowledge of healthcare regulations, policies, and procedures * Excellent communication and interpersonal skills, with the ability to effectively collaborate with healthcare providers, patients, and internal stakeholders * Strong analytical and problem-solving skills, with the ability to make informed decisions and resolve complex issues * Proficiency in electronic health records (EHRs) and other healthcare software systems * Ability to work in a fast-paced environment, with multiple priorities and deadlines **Preferred Qualifications** * Prior utilization management experience * Strong knowledge of Medicaid regulations and policies * Experience working in a healthcare management or insurance company setting * Certification in a relevant clinical specialty (e.g., case management, utilization review) **Guidance** * Long-term commitment to nursing is required **USA Job Market Trends** The job market in the United States is constantly evolving, with various trends and shifts affecting the way we work and live. Some key trends that have been impacting the job market include: * Remote work and hybrid models: The COVID-19 pandemic has led to a significant increase in remote work and flexible work arrangements, which may affect how jobs are structured in the future. * Technology and digital skills: The demand for technology-related skills, such as coding, data analysis, and virtual marketing, has been consistently high. * Healthcare and biotechnology: The pandemic has highlighted the importance of the healthcare sector, with a growing need for roles associated with healthcare, pharmaceuticals, biotechnology, and clinical research. * Renewable energy and sustainability: There has been increasing interest in renewable energy and sustainability practices, leading to growth in areas like clean energy, environmental conservation, and green technology. * E-commerce and logistics: The shift toward online shopping has driven a need for jobs in e-commerce platforms, delivery chain management, and last-mile logistics. * Cybersecurity: With the growing reliance on digital infrastructure, cybersecurity has become a critical concern, leading to a growing demand for expert professionals in cybersecurity and data protection. * Health and well-being: Companies are focusing more on employee well-being, leading to a growing need for roles associated with mental health support, wellness programs, and work-life balance initiatives. * Skilled trades and vocational roles: Skilled trades like electricians, plumbers, and mechanics have seen a shortage of workers, providing opportunities for those interested in vocational careers. * Diversity, equity, and inclusion (DEI): Organizations are placing more emphasis on creating diverse and inclusive work environments, leading to a growing need for roles focused on DEI initiatives. * Gig economy and freelancing: The gig economy continues to grow, providing opportunities for people to work as freelancers, consultants, and independent contractors in various industries. * Aging workforce and succession planning: The aging population has led to discussions about workforce planning and skills succession strategies in industries with a large percentage of older workers. * Reskilling and upskilling: Lifelong learning and continuous skill development have become essential as industries evolve rapidly. Many people are seeking opportunities to reskill or upskill to remain competitive in the job market. **Why Join arenaflex?** * Competitive salary and benefits package * Opportunities for professional growth and development * Collaborative and dynamic work environment * Commitment to diversity, equity, and inclusion * Recognition and rewards for outstanding performance * Comprehensive training and support **How to Apply** If you are a motivated and experienced clinical professional looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your qualifications and experience. We look forward to hearing from you! Apply for this job