Remote: not held to onsite requirements, however, leadership can request presence onsite for ... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ...
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ...
RN Field Case Manager
Phoenix, AZ · On-site +1
$77K - $98K/yr
Must be an RN and prefer to have as least 1.5 years of prior Field Case Manager workers ... 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
Must be an RN and prefer to have as least 1.5 years of prior Field Case Manager workers ... 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
Must be an RN and prefer to have as least 1.5 years of prior Field Case Manager workers ... 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
Must be an RN and prefer to have as least 1.5 years of prior Field Case Manager workers ... remote work environment that allows face to face interaction with injured workers and medical ...
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 responsible for identifying the physical, psychological, social, and spiritual needs of those patients and ...
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 responsible for identifying the physical, psychological, social, and spiritual needs of those patients and ...
Associate Director, RN Denials Management
Phoenix, AZ · On-site +1
Remote, Banner supplies equipment Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call) Ideal Candidate: * Must have at least 5 years' experience as an RN, with current licensure in ...
New
Associate Director, RN Denials Management
Phoenix, AZ · On-site +1
Remote, Banner supplies equipment Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call) Ideal Candidate: * Must have at least 5 years' experience as an RN, with current licensure in ...
New
Bilingual Clinical Nurse Coach (RN)
Phoenix, AZ · Remote
$80K - $100K/yr
US; remote with minimal travel Schedule: Monday - Friday, with three late shifts (11 am - 8 pm) and ... Must have an RN license in good standing and be willing to obtain licensure in other states. * A ...
Bilingual Clinical Nurse Coach (RN)
Phoenix, AZ · Remote
$80K - $100K/yr
US; remote with minimal travel Schedule: Monday - Friday, with three late shifts (11 am - 8 pm) and ... Must have an RN license in good standing and be willing to obtain licensure in other states. * A ...
Virtually Integrated Care Nurse
Prescott, AZ · On-site +1
$35 - $58.63/hr
Job Summary and Responsibilities As our Virtually Integrated Care RN , you will be a pivotal provider, empowering patients toward optimal health through comprehensive remote support and collaborative ...
Virtually Integrated Care Nurse
Prescott, AZ · On-site +1
$35 - $58.63/hr
Job Summary and Responsibilities As our Virtually Integrated Care RN , you will be a pivotal provider, empowering patients toward optimal health through comprehensive remote support and collaborative ...
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Registered Nurse (RN) Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Registered Nurse (RN) Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
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 ...
Initial Clinical Reviewer - Remote - AZ
Phoenix, AZ · On-site +1
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... 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
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to ...
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 ...
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
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 ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... including RN or LPN. Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... 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 ...
Remote 1099 NPs or APRNs - Hormone Replacement Therapy
Mesa, AZ · Remote
$60 - $90/hr
Active NP or APRN licenses in a minimum of 6 U.S. states * Active, unrestricted DEA license ... patient experience Remote Flexibility Work from home with scheduling options that fit your ...
Quick apply
Remote 1099 NPs or APRNs - Hormone Replacement Therapy
Mesa, AZ · Remote
$60 - $90/hr
Active NP or APRN licenses in a minimum of 6 U.S. states * Active, unrestricted DEA license ... patient experience Remote Flexibility Work from home with scheduling options that fit your ...
Remote 1099 NPs or APRNs - Hormone Replacement Therapy
Peoria, AZ · Remote
$60 - $90/hr
Active NP or APRN licenses in a minimum of 6 U.S. states * Active, unrestricted DEA license ... patient experience Remote Flexibility Work from home with scheduling options that fit your ...
Quick apply
Remote 1099 NPs or APRNs - Hormone Replacement Therapy
Peoria, AZ · Remote
$60 - $90/hr
Active NP or APRN licenses in a minimum of 6 U.S. states * Active, unrestricted DEA license ... patient experience Remote Flexibility Work from home with scheduling options that fit your ...
Utilization Review Nurse
Tempe, AZ · Remote
$35 - $45.94/hr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
Quick apply
Utilization Review Nurse
Tempe, AZ · Remote
$35 - $45.94/hr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...
High-Cost Claimant Review Unit Nurse Auditor
Phoenix, AZ · On-site +1
$38.25 - $50.50/hr
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Active, unrestricted license to practice as a registered nurse (RN) in the state of Arizona (a ...
High-Cost Claimant Review Unit Nurse Auditor
Phoenix, AZ · On-site +1
$38.25 - $50.50/hr
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Active, unrestricted license to practice as a registered nurse (RN) in the state of Arizona (a ...
Remote Qualifications: Education & Licensure (one of the following required ... Graduate of an accredited nursing program (RN, LPN, or LVN), or * Graduate of an accredited ...
Remote Qualifications: Education & Licensure (one of the following required ... Graduate of an accredited nursing program (RN, LPN, or LVN), or * Graduate of an accredited ...
Remote Oracle Rn information
What is the difference between Remote Oracle Rn vs Remote Oracle Database Administrator?
| Aspect | Remote Oracle Rn | Remote Oracle Database Administrator |
|---|---|---|
| Certifications | Oracle Nursing Certification, RN License | Oracle Certified Professional (OCP), Database Certification |
| Work Environment | Healthcare settings, clinics, hospitals | IT departments, data centers, corporate environments |
| Job Focus | Patient care, clinical procedures | Database management, system maintenance |
Remote Oracle Rn roles focus on patient care and clinical responsibilities in healthcare settings, requiring nursing licenses and healthcare certifications. In contrast, Remote Oracle Database Administrators handle database systems, requiring IT certifications and technical expertise. Both roles are remote but serve different industries and skill sets, making their job functions distinct despite similar titles.
RN Med Policy Development/Research Specialist (UM experience) - REMOTE-AZ
Phoenix, AZ • On-site, Remote
Full-time
Posted 27 days ago
Blue Cross Blue Shield Of Arizona rating
6.0
Based on 9 frontline employees who took The Breakroom Quiz
243rd of 262 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.
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