AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ...
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ...
Integrated Care Manager - Medicare Advantage (prior CM experience working in a health plan)- Remote
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... RN. Required Certifications * Within 4 years of hire as a Care Manager employee must hold a ...
Integrated Care Manager - Medicare Advantage (prior CM experience working in a health plan)- Remote
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... RN. Required Certifications * Within 4 years of hire as a Care Manager employee must hold a ...
Insurance Sales Agent (Remote)
Phoenix, AZ · On-site +1
$100K - $150K/yr
Every one of those customers comes to us already looking for a policy, through our mobile or web ... As an Insurance Sales Agent , your job is to take that interest and turn it into a bound policy ...
Insurance Sales Agent (Remote)
Phoenix, AZ · On-site +1
$100K - $150K/yr
Every one of those customers comes to us already looking for a policy, through our mobile or web ... As an Insurance Sales Agent , your job is to take that interest and turn it into a bound policy ...
RN Field Case Manager
Phoenix, AZ · On-site +1
$77K - $98K/yr
... Services & Insurance RN Field Case Manager This Field Case Manager will cover our Phoenix, AZ ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Phoenix, AZ · On-site +1
$77K - $98K/yr
... Services & Insurance RN Field Case Manager This Field Case Manager will cover our Phoenix, AZ ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Phoenix, AZ · On-site +1
$77K - $98K/yr
... Services & Insurance RN Field Case Manager This Field Case Manager will cover our Phoenix, AZ ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Phoenix, AZ · On-site +1
$77K - $98K/yr
... Services & Insurance RN Field Case Manager This Field Case Manager will cover our Phoenix, AZ ... remote work environment that allows face to face interaction with injured workers and medical ...
Fully Remote Schedule: Flexible Compensation: Up to $85 per hour Job Type: Full-time, Part-time ... Berry Street empowers independent dietitians to accept insurance and grow thriving private ...
Fully Remote Schedule: Flexible Compensation: Up to $85 per hour Job Type: Full-time, Part-time ... Berry Street empowers independent dietitians to accept insurance and grow thriving private ...
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... Registered Nurse (RN) Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... Registered Nurse (RN) Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
RN Quality Measure Specialist
Phoenix, AZ · Remote
$34.50 - $46.25/hr
This fully remote role focuses on validation, abstraction, and submission of clinical quality ... Ideal Candidate: * RN with 5 years acute care experience (ED, ICU, PACU, or similar preferred)
RN Quality Measure Specialist
Phoenix, AZ · Remote
$34.50 - $46.25/hr
This fully remote role focuses on validation, abstraction, and submission of clinical quality ... Ideal Candidate: * RN with 5 years acute care experience (ED, ICU, PACU, or similar preferred)
Remote Registered Dietitian or CNS - Flexible Hours, Work from Anywhere
Phoenix, AZ · On-site +1
$85/hr
Fully Remote Schedule: Flexible Compensation: Up to $85 per hour Job Type: Full-time, Part-time ... Berry Street empowers independent dietitians to accept insurance and grow thriving private ...
Remote Registered Dietitian or CNS - Flexible Hours, Work from Anywhere
Phoenix, AZ · On-site +1
$85/hr
Fully Remote Schedule: Flexible Compensation: Up to $85 per hour Job Type: Full-time, Part-time ... Berry Street empowers independent dietitians to accept insurance and grow thriving private ...
Position Overview We are seeking an exceptional Wound Care Nurse Practitioner to serve as a remote ... Active, unrestricted RN and APRN licenses in Arizona (additional APRN state licenses a plus)
Position Overview We are seeking an exceptional Wound Care Nurse Practitioner to serve as a remote ... Active, unrestricted RN and APRN licenses in Arizona (additional APRN state licenses a plus)
Position Overview We are seeking an exceptional Wound Care Nurse Practitioner to serve as a remote ... Active, unrestricted RN and APRN licenses in Arizona (additional APRN state licenses a plus)
Position Overview We are seeking an exceptional Wound Care Nurse Practitioner to serve as a remote ... Active, unrestricted RN and APRN licenses in Arizona (additional APRN state licenses a plus)
Initial Clinical Reviewer - Remote - AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to ...
Initial Clinical Reviewer - Remote - AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to ...
BH UM Clinical Reviewer- Remote AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... the Nursing Licensure Compact (NLC) as an RN. Required Certifications * N/A PREFERRED ...
BH UM Clinical Reviewer- Remote AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... the Nursing Licensure Compact (NLC) as an RN. Required Certifications * N/A PREFERRED ...
Call Center Telecare Registered Nurse - OVERNIGHT (Remote)
Phoenix, AZ · On-site +1
$36 - $41/hr
The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person ... insurance - Pre-tax healthcare and dependent care flexible spending accounts - Life insurance ...
Call Center Telecare Registered Nurse - OVERNIGHT (Remote)
Phoenix, AZ · On-site +1
$36 - $41/hr
The VITAS Telecare RN is a member of the interdisciplinary team who is the pivotal person ... insurance - Pre-tax healthcare and dependent care flexible spending accounts - Life insurance ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... including RN or LPN. Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of ... including RN or LPN. Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
Medical & Disability Nurse Case Manager
Chandler, AZ · Remote
$67K - $126K/yr
Description If you're a registered nurse looking for a new opportunity to work in a fast-paced ... This is a remote position however, you will be required to report into the office twice a month per ...
Medical & Disability Nurse Case Manager
Chandler, AZ · Remote
$67K - $126K/yr
Description If you're a registered nurse looking for a new opportunity to work in a fast-paced ... This is a remote position however, you will be required to report into the office twice a month per ...
Description If you're a registered nurse looking for a new opportunity to work in a fast-paced ... This is a remote position however, you will be required to report into the office twice a month per ...
Description If you're a registered nurse looking for a new opportunity to work in a fast-paced ... This is a remote position however, you will be required to report into the office twice a month per ...
Cardiopulmonary Patient Educator - Registered Nurse
Phoenix, AZ · Remote
$60K - $129K/yr
Registered Nurse, RN, Infusion, Infusion Therapy, Pulmonary, Cardiology, PAH, Central Venous ... Possess a valid and current driver's license and auto insurance. * Participate in the on call ...
Cardiopulmonary Patient Educator - Registered Nurse
Phoenix, AZ · Remote
$60K - $129K/yr
Registered Nurse, RN, Infusion, Infusion Therapy, Pulmonary, Cardiology, PAH, Central Venous ... Possess a valid and current driver's license and auto insurance. * Participate in the on call ...
Remote Healthcare Recruiter (General Healthcare - Nationwide)
Phoenix, AZ · Remote
$70K - $80K/yr
Remote Healthcare Recruiter (General Healthcare - Nationwide) Job Summary Gotham Enterprises Ltd is ... Familiarity with various medical licenses (LMHC, PT, RN, LPN, MD, DO, PA, NP) and the general ...
Remote Healthcare Recruiter (General Healthcare - Nationwide)
Phoenix, AZ · Remote
$70K - $80K/yr
Remote Healthcare Recruiter (General Healthcare - Nationwide) Job Summary Gotham Enterprises Ltd is ... Familiarity with various medical licenses (LMHC, PT, RN, LPN, MD, DO, PA, NP) and the general ...
GI Nurse Practitioner (Arizona, California,New Mexico, Nevada or Utah)
Flagstaff, AZ · Remote
$125K/yr
Current licensure as a Certified Registered Nurse Practitioner (CRNP) or Advanced Practice ... Remote-first -- work from home anywhere in the US * Growth: Advanced training by GI-specialized ...
Quick apply
GI Nurse Practitioner (Arizona, California,New Mexico, Nevada or Utah)
Flagstaff, AZ · Remote
$125K/yr
Current licensure as a Certified Registered Nurse Practitioner (CRNP) or Advanced Practice ... Remote-first -- work from home anywhere in the US * Growth: Advanced training by GI-specialized ...
Mobile Remote Rn Insurance information
What is the difference between Mobile Remote Rn Insurance vs Mobile Remote Lpn Insurance?
| Aspect | Mobile Remote Rn Insurance | Mobile Remote Lpn Insurance |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Licensed Practical Nurse (LPN) license |
| Work Environment | Remote, patient assessments, insurance documentation | Remote, basic patient support, insurance processing |
| Industry Usage | Commonly used in insurance and healthcare sectors | Used in similar sectors but with LPN-specific roles |
Mobile Remote Rn Insurance and Mobile Remote Lpn Insurance roles both involve remote work within the healthcare insurance industry. RNs typically handle more complex patient assessments and documentation, requiring RN licensure, while LPNs focus on basic support tasks. Both roles are essential in insurance processing and patient communication, but RNs generally have more advanced responsibilities.

RN Med Policy Development/Research Specialist (UM experience) - REMOTE-AZ
Phoenix, AZ • On-site, Remote
Full-time
Re-posted 8 days ago
Blue Cross Blue Shield Of Arizona rating
5.9
Based on 13 frontline employees who took The Breakroom Quiz
256th of 277 rated insurance
Job description
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 remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
- Perform medical technology research to support the Medical Director Staff and Medical Policy Panel with decisions to ensure that medical policies are consistent with the standards of accepted medical practice in the community.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
- 2 year(s) of experience in clinical field of practice, health insurance, or other health care related field (All Levels)
- 1 year(s) of experience in medical policy and technology research field (Applies to Level 2)
- 2 year(s) of experience in medical policy and technology research field (Applies to Level 3)
Required Education
- Associate's Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program (Applies to All Levels)
Required Licenses
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels)
Required Certifications
- N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
- 3 year(s) of experience in clinical field of practice, health insurance, or other health care related field (All Levels)
- 1 year(s) of experience in claims retrospective review, utilization management, case management, appeals and grievances or quality review field (Applies to All Levels)
- Bachelor's Degree in Nursing or related field of study (Applies to All Levels)
- Active, current, and unrestricted State of Arizona (a state in the United States) license to practice as a Registered Nurse (Applies to All Levels)
- N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Level 1
- Perform medical technology research related to coverage guidelines and new technology and provide evaluation and summarization to Medical Director Staff and/or Medical Policy Panel
- Perform medical technology research as requested by other areas of BCBSAZ thru the Medical Policy Referral Form
- Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel
- Communicate medical policy information in protocol format to all areas of BCBSAZ requiring this information
- Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion and, as required, on the Clinical Coding Governance Committee (CCGC).
- Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies, such as BCBS Association Medical Policy Reference Manual, MCG care guidelines and/or Change Healthcare InterQual, and eviCore criteria.
- From the direction of management, Medical Director staff or Medical Policy Panel, facilitate external consultant reviews concerning a coverage guideline or new technology. Responsible for initiating the consultation and providing a summarization concerning the external review to the requestor. Responsible for arrangements for appropriate reimbursement for the consultant's review.
- Communicate medical policy information in protocol format to healthcare providers upon request
- With moderate assistance and review by management, perform basic level of code review
- 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
- Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
Level 2
- Working independently, recognizes necessity of an external consultant review concerning a coverage guideline or new technology, summarizing and reporting this information to management to facilitate the process as outlined for Level II
- With review by management, independently perform intermediate code review with knowledge and understanding of coverage guideline development/revisions with recommendations to the Clinical Coding Governance Committee (CCGC) for integration into benefit programming
- Responsible for the training, development and support of grade level I staff under an established training program
Level 3
- With review by management, independently perform advanced code review with advanced knowledge and understanding of coverage guideline development/revisions with recommendations to the Clinical Coding Governance Committee (CCGC) for integration into benefit programming.
- Working independently, initiate research from resource materials, e.g., clinical journals, periodicals, CMS (Medicare) guidelines and publications, BCBSA publications, other BCBS plans, and internet resources relating to technical, clinical and coverage guidelines, summarizing and reporting this information to management for further action
- Responsible for the training, development and support of grade level I and II staff under an established training program
LEVEL 4
- Assist manager with the implementation of daily operations with regard to guideline development and revisions, staff supervision, as well as necessary coaching to help each staff member reach personal, professional and department goals
- Assist manager with the coordination of all aspects of the Medical Policy Panel and Medical Director Meeting, including preparation, agenda and minutes.
- Assist manager with the completion of the monthly, quarterly and annual reporting to Director
- Assist manager with the coordination of all aspects of the annual review(s) of MCG, eviCore and/or Change Healthcare InterQual criteria updates
- Assist manager with providing oversight to responsible staff for the monthly review of BCBS Association Medical Policy and Reference Manual (MPRM) updates
- Assist manager with providing the initial training and instruction for both professional and technical staff and designating the oversight of staff regarding training of new staff at the desk level of instruction/training
- Responsible for the training, development and support of grade level III staff under an established training program
- Conduct, and/or participate in internal committees that further the goals of BCBSAZ, the Health Services Division and the Medical Policy & Technology Department
- Working independently, perform advanced code review with advanced knowledge and understanding of coverage guideline development/revisions with recommendations to the Clinical Coding Governance Committee (CCGC) for integration into benefit programming
ALL LEVELS
- Each progressive level includes the ability to perform the essential functions of any lower levels.
- The position has an onsite expectation of 0 days per week and 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
- Intermediate Adobe PDF Standard proficiency
- Intermediate word processing, spreadsheet and presentation software proficiency (Applies to 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
- 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
- Independent and sound judgment with good problem solving skills (Applies to All Levels)
Required Leadership Experience and Competencies
- N/A
PREFERRED COMPETENCIES
Preferred Job Skills
- Advanced PC proficiency
- Advanced Adobe PDF Standard proficiency
- Advanced processing, spreadsheet and presentation software proficiency (Applies to All Levels)
Preferred Professional Competencies
- N/A
Preferred Leadership Experience and Competencies
- Participate in strategic planning
- Resolve conflicts
- Represent BCBSAZ in the community (Applies to All Levels)
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.
What Blue Cross Blue Shield Of Arizona employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Blue Cross Blue Shield of Arizona
Sourced by ZipRecruiter
Industry
Insurance services
Company size
1,001 - 5,000 Employees
Headquarters location
Phoenix, AZ, US
Year founded
1939