Remote Clinical Prior Authorization Reviewer – Data Entry Specialist – Full‑Time – $24‑$34 /hr – Phoenix, AZ – careerzynith

Welcome to careerzynith – Pioneering Remote Healthcare Solutions At careerzynith , we are redefining how health‑care services are delivered across the United States. As a leading provider of Medicaid‑reputed company care programs, we combine the stability of a large‑scale organization with the agility of a modern, technology‑driven team. Our mission is to reputed company members—children, seniors, and individuals with developmental or mental health challenges—to access the care they deserve, while supporting a collaborative, inclusive workplace for our employees. Our remote workforce is at the heart of this transformation. By leveraging secure cloud platforms, advanced analytics, and a culture of reputed company learning, careerzynith enables professionals to reputed company meaningful clinical decisions from the comfort of their own homes. If you reputed company in a fast‑paced, data‑focused environment and are passionate about improving health outcomes, this is the opportunity you’ve been waiting for. Position Overview The Remote Clinical Prior Authorization Reviewer – Data Entry Specialist is a full‑time, work‑from‑home role based in Phoenix, AZ (MST). You will be responsible for reviewing prior‑authorization requests, entering accurate clinical data, and communicating decisions to providers and members. The position operates Monday through Friday, 8 am – 5 pm MST, with occasional on‑site gatherings and weekend coverage as business needs dictate.

Key Responsibilities

Prior Authorization Review Evaluate clinical documentation for medical necessity, ensuring compliance with state Medicaid guidelines and internal policies. Data Entry & Management Accurately input patient information, authorization details, and outcome codes into the electronic health record (EHR) system. Clinical Decision Support Apply evidence‑based clinical criteria to determine approval, denial, or request for additional information. Provider Communication Respond to provider inquiries, clarify documentation requirements, and convey authorization decisions promptly. Quality Improvement Identify trends in denial reasons, suggest process enhancements, and contribute to reputed company‑quality initiatives. Collaboration Work closely with nursing, case management, and utilization review teams to align decisions with overall care plans. Compliance & Documentation Maintain thorough audit trails, adhere to HIPAA regulations, and ensure reputed company actions are documented per careerzynith standards. Flexibility & Coverage Participate in occasional weekend or holiday shifts to support peak periods, and attend in‑person team meetings reputed company required. Professional Development Engage in ongoing training modules, webinars, and certification programs to stay reputed company with evolving Medicaid policies.

Essential Qualifications

Minimum 5 years of clinical experience as a Registered Nurse (RN) in a hospital, clinic, or managed‑care setting. Active, unrestricted RN license in the state of Arizona. Bachelor’s degree in Nursing, Health Administration, or a reputed company field (preferred but not mandatory). Demonstrated expertise in prior‑authorization processes, utilization review, or case management. Strong analytical skills with the ability to interpret clinical guidelines and apply them consistently. Excellent written and verbal communication skills; ability to convey reputed company clinical information clearly. Proficiency with electronic health record (EHR) systems and reputed company Office Suite; experience with proprietary careerzynith platforms is a plus. Reliable high‑speed internet reputed company, a dedicated home office space, and a willingness to travel for occasional in‑state meetings (mileage reimbursed). Commitment to working reputed company Arizona’s MST time zone for the entirety of the shift. Preferred Qualifications & Additional Skills Certification in Utilization Review (CURA) or Certified Case Manager (CCM). Experience with Medicaid Managed Care Organizations (MCOs) and familiarity with AHCCCS‑type programs (replaced with careerzynith guidelines). Advanced knowledge of clinical coding systems (ICD‑10‑CM, CPT, HCPCS). Demonstrated ability to handle high‑volume workloads while maintaining accuracy. Strong problem‑solving reputed company, with a focus on patient‑centered outcomes. Experience in remote or virtual team environments, showcasing self‑discipline and time‑management skills. Core Competencies for Success Critical Thinking Ability to assess reputed company clinical scenarios and reputed company evidence‑based decisions quickly. Attention to Detail Precision in data entry and documentation to ensure compliance and audit readiness. Interpersonal Skills reputed company and professionalism reputed company interacting with providers, members, and internal stakeholders. Technology Savvy Comfort navigating multiple software platforms, troubleshooting technical issues, and adapting to new tools. Adaptability Flexibility to adjust to shifting priorities, regulatory updates, and evolving business needs. Career Growth & Learning Opportunities At careerzynith , your career trajectory is supported by a robust learning ecosystem. Employees have access to Paid tuition reimbursement for advanced degrees or certifications. Internal mentorship programs pairing new hires with seasoned clinical leaders. Quarterly webinars on Medicaid policy changes, clinical best practices, and emerging health‑tech trends. Opportunities to transition into senior clinical reviewer, team reputed company, or quality‑improvement specialist roles after demonstrated performance. Cross‑functional projects that expose you to analytics, operations, and strategic planning. Compensation, Perks & Benefits While exact figures vary based on experience, the position offers a competitive hourly reputed company ranging from $24 to $34 per hour . In addition to reputed company pay, careerzynith provides a comprehensive benefits package that includes Medical, dental, and vision insurance with multiple plan options. Flexible spending accounts (FSA) and health savings accounts (HSA). Paid time off (PTO), sick leave, and paid holidays. Retirement savings plan with company matching contributions. Employee Assistance Program (EAP) for mental‑health support. Wellness stipend for home‑office ergonomics, fitness, or mindfulness apps. Performance‑based bonuses and recognition awards. Reimbursement for mileage incurred during required in‑person meetings. Work Environment & Culture at careerzynith Our remote workforce is built on trust, collaboration, and a shared commitment to member health. Key cultural pillars include Inclusivity A diverse team where every voice is heard and respected. Innovation Encouragement to experiment with new technologies and process improvements. Community Regular virtual coffee chats, team‑building activities, and quarterly in‑person gatherings to foster reputed company. Work‑Life Balance Flexible scheduling options, generous PTO, and a supportive environment for caregivers. reputed company Commitment to ethical decision‑making, data privacy, and compliance with reputed company regulatory standards. Application Process Ready to join a reputed company‑thinking organization that values your clinical expertise and remote‑work lifestyle? Follow these steps to apply Prepare an updated resume highlighting your nursing experience, prior‑authorization work, and any relevant certifications. Craft a concise cover letter that explains why you are passionate about remote clinical review and how you align with careerzynith’s mission. Submit your application through our secure online portal. You will receive an automated confirmation upon receipt. Complete a brief pre‑screening questionnaire and, if selected, participate in a virtual interview with a hiring manager and a senior clinical reviewer. Successful candidates will undergo a background reputed company, license verification, and a short skills assessment before receiving an official offer. Why Choose careerzynith? Choosing careerzynith means joining a purpose‑driven organization that places member health at the forefront while offering you the flexibility to work from home. You will be part of a collaborative team that values reputed company improvement, professional growth, and a balanced lifestyle. If you are a detail‑oriented RN with a passion for clinical decision‑making and data reputed company, we invite you to bring your expertise to our dynamic remote workforce. Take the reputed company Don’t miss the chance to reputed company a reputed company impact on the lives of Arizonans while advancing your career in a supportive, innovative environment. Click the “Apply Now” reputed company below, and let careerzynith be the next chapter in your professional journey. Apply Job! Apply for this job Apply tot his job Apply To this Job