Healthcare Consultant III

Top Requirements
- Active Compact RN License must be unrestricted and valid.
- 3+ years of recent clinical RN experience in acute care, ED, ICU, Med/Surg, Telemetry, or Home Health. A strong clinical foundation is needed to make accurate PA determinations.
- Prior Authorization or Utilization Review experience OR strong criteriabased clinical decisionmaking skills. Experience with MCG, InterQual, Medicare NCD/LCD, or similar guidelines preferred.
- Collaborative, teamoriented approach with a positive, professional attitude.
- Comfort with highvolume, repetitive work and the ability to remain focused while performing similar tasks daily.
- Willingness to work occasional weekends, if needed.

***Questionnaire to attach at the top of the resume***
- Do you currently hold an active Compact RN license? Please attach a copy or screenshot.
- How many years of RN clinical experience do you have? Which clinical areas have you worked in?
- Do you have experience with outpatient prior authorization or utilization review? If yes, briefly describe your responsibilities (12 sentences).
- Which clinical guidelines or criteria have you used? (e.g., MCG, InterQual, Medicare NCD/LCD)
- Which systems have you used? Have you supported a system transition (testing, workflow validation, UAT, etc.)?
- Do you have a dedicated, interruptionfree home workspace?
- Are you able to work a full 40hour week aligned to the Arizona time zone? (MondayFriday, 8:30AM5:00PM Client time)

The RN Outpatient Prior Authorization performs clinical review of outpatient service requests using medical necessity criteria, evidence based guidelines, and organizational policy. This role is dedicated to outpatient prior authorization only and supports high-quality, accurate, and timely determinations.

The position will play a key role in the transition from QNXT to MedCompass, including workflow validation, testing, and stabilization of new processes during implementation.

Interview Period: March 16 March 27
All Offers Out and Accepted By: April 1
Candidates Fully Cleared By: April 17
Targeted Start Date for Hires: May 4

Position Summary:

The RN Outpatient Prior Authorization performs clinical review of outpatient service requests using medical necessity criteria, evidence based guidelines, and organizational policy. This role is dedicated to outpatient prior authorization only and supports high quality, accurate, and timely determinations.

The position will play a key role in the transition from QNXT to MedCompass, including workflow validation, testing, and stabilization of new processes during implementation.

Duties:

Key Responsibilities:
-Review outpatient prior authorization requests and apply appropriate medical necessity criteria (local/state guidelines, Medicare NCD/LCD, MCG where applicable).
-Gather and interpret clinical information and document accurate review outcomes.
-Ensure compliant, timely determinations aligned with state/federal requirements.
-Participate in MedCompass implementation activities: user testing, workflow validation, defect identification, and process refinement.
-Communicate determination outcomes professionally to providers and internal partners.
-Maintain high accuracy, reliability, and auditready documentation standards.

Experience:

Required Qualifications
-Active and unrestricted RN license (Compact).
-Minimum 3 years clinical experience (acute care, ED, ICU, Telemetry, Med/Surg, Home Health, etc.).
-Ability to work a 40hour workweek aligned to the Arizona time zone.

Preferred Qualifications
-Prior authorization or utilization management experience.
-Experience with MCG, InterQual, QNXT, or similar systems.
-Experience in system transitions or healthcare technology implementations.
-BSN preferred.

Competency Expectations
-High accuracy and quality in clinical decision making and documentation.
-Proficiency with criteria application (NCD/LCD, Medicaid policy, MCG).
-Adaptability during system change and workflow stabilization.

Education:

Associates Degree in Nursing
Active Compact RN License