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Utilization Management Clinical Consultant
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Full-time
- Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985.
- We hold multiple contracts with AHCCCS, Arizonas Medicaid agency, and deliver services throughout the state.
- Mercy Care is administered by Aetna, a CVS Health company.
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
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