Utilization Review Assistant Jobs in Arizona (NOW HIRING)

"Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for ourpatients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of ourpatients and their families creating a memorableexperiencethrough compassion, respect,and kindness."

Job Summary

The Case Management Coordinator manages the transition of care for members post-discharge and those with chronic conditions, coordinating follow-up care, creating personalized care plans, and educating patients and caregivers, to prevent hospital readmissions, reduce over-utilization, and improve overall health outcomes.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Conduct timely post-discharge outreach (within 24-72 hours), reviewing discharge summaries, medication lists, and follow-up recommendations, to assess member needs, confirm understanding of medical instructions, and identify immediate gaps in care.
• Coordinate follow-up appointments and post-acute services, collaborating with primary care providers, specialists, home health agencies, and community resources, to ensure seamless continuity of care across the continuum.
• Develop and implement individualized care plans based on assigned program categories, identifying early signs of complications or risk factors, to manage chronic conditions effectively and escalate clinical issues appropriately.
• Educate members and caregivers using motivational interviewing techniques, providing guidance on red-flag symptoms and self-management strategies, to empower patients and reduce patterns of over-utilization (e.g., frequent ED visits).
• Document all interactions, assessments, and clinical interventions in the care management platform accurately and timely, to maintain compliance with organizational policies, advocate for member needs, and ensure alignment with clinical guidelines.

Supervisory Responsibilities

This position currently has no supervisory responsibilities

Required Education

• High school diploma or equivalent.
• Graduation from a nationally accredited Medical Assistant (MA) program

Required Experience

Proven experience in clinical case management, care coordination, utilization review, or population health management within a healthcare setting.

Required Licenses and Certifications

• Active MA national certification.
• CPR/BLS for Healthcare Providers is required.

Required Knowledge, Skills, and Abilities

• Clinical Knowledge: Strong, demonstrated understanding of chronic disease management, evidence-based medical guidelines, and post-acute care processes.
• Patient Engagement: Proficiency in motivational interviewing techniques to effectively educate and empower members and their caregivers.
• Communication: Excellent verbal and written communication skills to interact effectively with patients, interdisciplinary care teams, and community partners.
• Problem-Solving: Strong critical thinking and clinical problem-solving skills to identify barriers to care, risk factors for readmission, and appropriate transition plans.
• Technical Skills: Ability to accurately and timely document assessments and interventions in care management platforms or Electronic Medical Records (EMR).

Preferred Qualifications

• Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review.
• Bilingual (English and Spanish) to effectively serve diverse member populations.

Financial Responsibilities

This position currently has no financial responsibilities.

Budget Responsibilities

This position currently has no budget responsibilities.

Languages

• Advanced English is required.
• Bilingual Spanish/Creole is preferred.

Travel

This position does not currently require travel.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Includes corporate and medical center administrative staff whose primary duties are office-based. These positions generally require prolonged sitting, computer use, occasional standing and walking, and the ability to lift or carry up to 20 pounds, with occasional travel between company locations as needed.

Environmental Conditions

Inside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.

Physical/Environmental Activities

Please confirm for the following questions if these working conditions are encountered Occasionally (1-33% of time on the job), Frequently (34-66% of time on the job), Constantly (67-100% of time on the job), or Not Applicable N/A

• Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).Not Applicable N/A
• May be exposed to outdoor weather conditions of cold, heat, wet, and humidity.Not Applicable N/A
• May be exposed to outdoor or warehouse conditions of loud noises, vibration, fumes, dust, odors, and mists.Not Applicable N/A
• Must be able to ascend and descend ladders, stairs, or other equipment.Not Applicable N/A
• Subject to exposure to hazardous material.Not Applicable N/A

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.

This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of the company. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder's responsibility