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Flexible Remote Rn Jobs in Arizona (NOW HIRING)

Bannerhealth

RN, Case Manager

Tucson, AZ · Remote

After completing training, it is a remote position with a work schedule of Monday - Friday 8am ... For assignments in an acute care setting, must be able to work flexible hours and take rotating ...

Banner Health

RN, Case Manager

Phoenix, AZ · Remote

After completing training, it is a remote position with a work schedule of Monday - Friday 8am ... For assignments in an acute care setting, must be able to work flexible hours and take rotating ...

UnitedHealth Group

Case Manager RN

Phoenix, AZ · Remote

$60K - $107K/yr

The RN Care Coordinator is responsible for managing patients attributed to provider practices ... Adaptable, flexible, and able to incorporate frequent process changes into established workflows ...

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Flexible Remote Rn information

What are the key skills and qualifications needed to thrive as a Flexible Remote RN, and why are they important?

To thrive as a Flexible Remote RN, you need active RN licensure, strong clinical judgment, and broad nursing experience to provide safe, effective care virtually. Familiarity with telehealth platforms, electronic health records (EHRs), and remote monitoring tools is essential for managing patient care remotely. Excellent communication, self-motivation, and adaptability are crucial soft skills for engaging with patients and collaborating with healthcare teams from a distance. These skills and qualities are vital for delivering high-quality patient care, ensuring compliance, and maintaining productivity in a remote, technology-driven environment.

What is the difference between Flexible Remote Rn vs Flexible Remote Lpn?

AspectFlexible Remote RnFlexible Remote Lpn
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote nursing, patient assessments, care planningRemote nursing, basic patient care, documentation
Employer & Industry UsageHospitals, clinics, telehealth companiesLong-term care facilities, telehealth providers
Common Search & ComparisonYesYes

The main difference between Flexible Remote Rn and Flexible Remote Lpn lies in their credentials and scope of practice. RNs typically have a broader scope, including patient assessments and care planning, while LPNs focus on basic patient care and documentation. Both roles are in demand for remote healthcare services, but RNs generally require more advanced training and licensing.

What are Flexible Remote RNs?

Flexible Remote RNs are registered nurses who provide healthcare services remotely, often from home, using telehealth technologies. They have flexible schedules and may work part-time, per diem, or on shifts that suit their availability. Their responsibilities can include patient education, triage, care coordination, and follow-up calls, all conducted through phone or video conferencing. This role allows nurses to utilize their skills without being physically present in a healthcare facility, making it ideal for those seeking work-life balance.

What are some common challenges faced by Flexible Remote RNs, and how can they be effectively managed?

Flexible Remote RNs often encounter challenges such as adapting to diverse patient needs across various settings, managing time efficiently without in-person supervision, and ensuring clear communication with healthcare teams virtually. To effectively manage these challenges, it is important to develop strong organizational skills, stay updated with telehealth technologies, and maintain proactive communication with colleagues and patients. Regular participation in virtual team meetings and ongoing professional development can also help RNs stay connected and provide high-quality care remotely.
What are the most commonly searched types of Remote Rn jobs in Arizona? The most popular types of Remote Rn jobs in Arizona are:
What cities in Arizona are hiring for Flexible Remote Rn jobs? Cities in Arizona with the most Flexible Remote Rn job openings:
Flexible Remote Rn jobs near you
Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Medical

Posted 23 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

263rd of 281 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  • Onsite: daily onsite requirement based on the essential functions of the job
  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is remote within Arizona or in an approved out-of-state location. Applicants must reside in-and perform work from-the state of Arizona or an approved out-of-state location.
Purpose of the job
Responsible for utilizing clinical acumen and managed care expertise related to researching, resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business with emphasis on privacy, accuracy, meeting all regulatory and compliance timelines.
Qualifications
REQUIRED QUALIFICATIONS
Required Work Experience
Level 1
  • 1 year Experience in clinical and health insurance or other healthcare related field

Level 2
  • 3 years' Experience in clinical and health insurance or other healthcare related field
  • 1 year' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 3
  • 5 years' Experience in clinical and health insurance or other healthcare related field
  • 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 4
  • 8 years' Experience in clinical and health insurance or other healthcare related field
  • 3 years' Above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Required Education
  • Associate's Degree in a healthcare field of study or Nursing Diploma (Applies to All Levels)

Required Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN)

Required Certifications
  • N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience
Level 1
  • 3 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits

Level 2
  • 5 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 2 years' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 3
  • 7 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 5 years' Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Level 4
  • 9 years' Experience in clinical and health insurance or other healthcare related field. Working knowledge of eviCore, MCG, McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies. Advanced ability to interpret contract language and benefits
  • 5 years' Above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)

Preferred Education
  • Bachelor's Degree in Nursing or related field of study (Applies to All Levels)

Preferred Licenses
  • N/A

Preferred Certifications
  • N/A

ESSENTIAL job functions AND RESPONSIBILITIES
Level I
  • Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
  • Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
  • Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
  • Maintain complete and accurate records per department policy.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
  • Demonstrate ability to apply plan policies and procedures effectively.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
  • Attend staff and interdepartmental meetings.
  • Participate in continuing education and current developments in the fields of medicine and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • Maintain productivity and accuracy goals based on regulatory requirements, accreditation standards, and service level agreements.
  • Demonstrate ability to acquire specialized knowledge to complete all types of level one appeals, grievances and corrected claims for local lines of business using appropriate benefit plan booklet, administrative guidelines and policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research and precertification research.
  • Articulate to customers a variety of information about the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, and provider networks.
  • Adheres to BCBSAZ brand promise of being a "Trusted Advisor" by walking in the customers shoes including processing work using the principles of easy, effective, emotional

level II
  • Ability to demonstrate specialized knowledge to administer Federal Employee Program (FEP)inquiries, appeals, grievances and sub-reconsiderations using appropriate service benefit plan provisions, and internal policies, medical criteria guidelines, claims research, provider contracts and fee schedules, communication records research, and precertification research.
  • Ability to demonstrate specialized knowledge to perform reviews for local lines of business, Blue Card Home member appeals and grievances, and Blue Card Host provider grievances. MAG Clinicians also support FEP for member reconsiderations, provider appeals, corrected claims and inquiries.

level III
  • Ability to demonstrate specialized knowledge to complete all Levels of Medical Appeals and Grievance (MAG) cases (Initial internal, voluntary internal and external review appeals and grievances).
  • Under minimal direction, lead interdepartmental meetings and oversee special projects as assigned.
  • Assist in developing new policies and procedures, desk levels, and job aids as needed.
  • Assist in training new staff and provide ongoing training for existing staff as needed.
  • Assist in distribution of staff Flow Manager case assignments.
  • Identify and recommend process improvements.

level IV
  • Assist in distribution of staff case assignments.
  • Under minimal direction, prepare reports and documentation for committee presentation and ad hoc reports as needed.
  • Analyze appeals and grievances data and make recommendations based on trends identified.
  • Take initiative to follow through on issues and opportunities for process improvements.
  • Initiate, develop and implement in-service educational presentations.
  • Work collaboratively with management and provide leadership for the department in day to day activities as well as in management's absence.
  • Maintain a working knowledge of all activities in the department and provide assistance to departmental staff and interdepartmental staff as necessary.
  • Consistently demonstrate alignment with the BCBSAZ "Living our Values" culture by participating in annual, community service campaigns and/or projects such as, CARES Club, United Way and/or community wellness initiatives (Walk for Hope, Walk to Stop Diabetes, Phoenix Heart Walk, etc).

ALL LEVELS
  • Each progressive level includes the ability to perform the essential functions of any lower levels.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned

competencies
REQUIRED COMPETENCIES
Required Job Skills
  • Intermediate PC proficiency (All Levels)
  • Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones (All Levels)

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Advanced clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities under limited time constraints
  • Independent and sound judgment with good problem solving skills
  • Ability to assist in training of new and existing staff (Applies to Levels 3 and 4)

Required Leadership Experience and Competencies
  • Ability to revise departmental policies and procedures and desk levels as well as develop new policies and procedures and desk levels as needed (Applies to Levels 3 and 4)
  • Proven leadership and assistance through positive reinforcement of processes and company policies
    (Applies to Levels 3 and 4.)

PREFERRED COMPETENCIES
Preferred Job Skills
  • Advanced PC proficiency
  • Knowledge of Current CPT, ICD- 9, ICD-10, HCPCS, and DRG coding

Preferred Professional Competencies
  • Working knowledge of McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies
  • Advanced ability to interpret contract language and benefits

Preferred Leadership Experience and Competencies
  • N/A

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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