Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC) ESSENTIAL ... Review medical records and determine medical necessity based on criteria and benefits * Present ...
Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC) ESSENTIAL ... Review medical records and determine medical necessity based on criteria and benefits * Present ...
Lead, Clinical Reviewer
Phoenix, AZ · Remote
... oversight of RNs, PTs, OTs, and other disciplines as needed Office Location: * Remote ... Strong knowledge of utilization review practices * PC literate, including Microsoft Office products ...
Lead, Clinical Reviewer
Phoenix, AZ · Remote
... oversight of RNs, PTs, OTs, and other disciplines as needed Office Location: * Remote ... Strong knowledge of utilization review practices * PC literate, including Microsoft Office products ...
Call Center: Telecare Registered Nurse (RN) (REMOTE)
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Call Center: Telecare Registered Nurse (RN) (REMOTE)
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Call Center: Telecare Registered Nurse (RN) (REMOTE)
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Call Center: Telecare Registered Nurse (RN) (REMOTE)
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Call Center: Telecare Registered Nurse (RN) (REMOTE) Mesa AZ
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Call Center: Telecare Registered Nurse (RN) (REMOTE) Mesa AZ
Phoenix, AZ · On-site +1
$36 - $41/hr
... care facility staff, case managers, and others external to VITAS as necessary. Provides ... Reviews all entries in the record made by Telecare LPN/LVN's and Patient Care Coordinators and ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
... including RN or LPN. Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ... Utilize clinical skills, chart review, physician communication and appropriate criteria for ...
Prior Authorization Nurse - Remote - AZ
Phoenix, AZ · On-site +1
... including RN or LPN. Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ... Utilize clinical skills, chart review, physician communication and appropriate criteria for ...
... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ... review, utilization management, case management, appeals and grievances or quality review field ...
... RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels) Required Certifications * N/A PREFERRED ... review, utilization management, case management, appeals and grievances or quality review field ...
BH UM Clinical Reviewer- Remote AZ
Phoenix, AZ · On-site +1
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... the Nursing Licensure Compact (NLC) as an RN. Required Certifications * N/A PREFERRED ...
BH UM Clinical Reviewer- Remote AZ
Phoenix, AZ · On-site +1
Remote: not held to onsite requirements, however, leadership can request presence onsite for ... the Nursing Licensure Compact (NLC) as an RN. Required Certifications * N/A PREFERRED ...
NCLEX-RN Tutor
Glendale, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Glendale, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Tempe, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Tempe, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Gilbert, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Gilbert, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Mesa, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Mesa, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Scottsdale, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Scottsdale, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Chandler, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Chandler, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Phoenix, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
NCLEX-RN Tutor
Phoenix, AZ · Remote
$18 - $40/hr
... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...
Registered Nurse Coach Dementia Program
Phoenix, AZ · On-site +1
$89K - $166K/yr
The Case Management (CM) Registered Nurse (RN) is responsible for providing competent, evidence ... Expedited Candidate Review Once the announcement closes, Human Resources will quickly review ...
Registered Nurse Coach Dementia Program
Phoenix, AZ · On-site +1
$89K - $166K/yr
The Case Management (CM) Registered Nurse (RN) is responsible for providing competent, evidence ... Expedited Candidate Review Once the announcement closes, Human Resources will quickly review ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Quick apply
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Quick apply
Benefits All Remote Hospice Triage RNs, once trained to their originally assigned team are paid $25 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn ...
Remote Rn Case Review information
See Gilbert, AZ salary details
$19.17 - $24.68
3% of jobs
$24.68 - $30.19
6% of jobs
$35.19 is the 25th percentile. Wages below this are outliers.
$30.19 - $35.70
17% of jobs
$35.70 - $41.21
20% of jobs
The median wage is $42.32 / hr.
$41.21 - $46.73
16% of jobs
$46.73 - $52.24
11% of jobs
$53.42 is the 75th percentile. Wages above this are outliers.
$52.24 - $57.75
7% of jobs
$57.75 - $63.26
6% of jobs
$63.26 - $68.77
5% of jobs
$68.77 - $74.28
4% of jobs
$74.28 - $79.79
3% of jobs
$19
$47
$79
How much do remote rn case review jobs pay per hour?
What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?
| Aspect | Remote Rn Case Review | Remote Rn Utilization Review |
|---|---|---|
| Credentials | Registered Nurse (RN), licensure, case review certifications | Registered Nurse (RN), licensure, utilization review certifications |
| Work Environment | Remote, healthcare settings, insurance companies | Remote, healthcare settings, insurance companies |
| Employer & Industry | Hospitals, insurance firms, healthcare providers | Insurance companies, healthcare management organizations |
Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.
- Remote Utilization Management
- Part Time Remote Utilization Review Nurse
- Remote Integrative Medicine Rn
- Remote Rn Government
- Evening Remote Telephonic Nurse Case Manager
- Remote Registered Dental Nurse
- Remote Rn Work From Home Prn
- Remote Registered Nurse Paid Training Program
- Temporary Utilization Review Nurse
- Night Utilization Review Nurse
Integrated Care Manager- Adult - Remote-AZ
Phoenix, AZ • On-site, Remote
Full-time
Medical
Posted 7 days ago
Blue Cross Blue Shield Of Arizona rating
5.9
Based on 13 frontline employees who took The Breakroom Quiz
263rd of 281 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
Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan. Ensures care meets individual healthcare needs while promoting quality and cost-effective outcomes. This role is primarily focused on case management but may assist with utilization management if needed.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
- 2 years of full-time equivalent experience in direct clinical care to consumers
Required Education
- Associate's Degree in a general field of study OR
- Post High School Nursing Diploma OR
- Master's Degree in a behavioral health field (MSW, MA, MS, M.Ed.), Ph.D., or Psy.D
Required Licenses
- Active, current, unrestricted license in Arizona (or eligible via endorsement) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.) OR
- Active, current, unrestricted RN license in Arizona or a Nurse Licensure Compact (NLC) state
Required Certifications
- Within 4 years of hire, must obtain one of the following case management certifications:
CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, or RN-BC
PREFERRED QUALIFICATIONS
Preferred Work Experience
- 3 years of direct clinical care experience (managed care case management preferred)
- 1-2 years of experience in a managed care organization
Preferred Education
- Bachelor's Degree in Nursing or Health and Human Services
Preferred Licenses
- None
Preferred Certifications
- Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC)
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Assess and collect member data from all care settings
- Collaborate with providers, members, and families to implement care plans
- Handle high-volume health insurance-related customer calls daily
- Explain benefits, coverage, eligibility, claims, programs, and networks
- Review medical records and determine medical necessity based on criteria and benefits
- Present case status updates to leadership and medical director as needed
- Coordinate with internal departments, providers, and external agencies
- Meet quality, productivity, and timeliness standards
- Maintain compliance with state, federal, and accreditation requirements
- Ensure accurate and complete documentation
- Apply policies and procedures effectively
Team Support (when applicable)
- Assist in workload distribution
- Monitor and report team progress
- Communicate issues and improvement opportunities
- Mentor and support team members
- Participate in continuing education in healthcare, behavioral health, and managed care annually
Work Schedule
- Full-time role (minimum 40 hours per week)
- Additional hours may be required based on business needs
- Perform other duties as assigned
COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
- Intermediate PC skills
- Intermediate use of office equipment (copiers, fax, scanners, phones)
- Intermediate skills in word processing, spreadsheets, and databases
Required Professional Competencies
- Maintain confidentiality and privacy
- Advanced clinical knowledge
- Strong interpersonal and active listening skills
- Ability to interpret and explain policies and procedures
- Strong analytical and research skills
- Organizational skills with ability to manage multiple priorities
- Ability to follow direction
- Team collaboration skills
- Sound judgment and problem-solving ability
- Ability to manage and maintain data across multiple systems
Required Leadership Competencies
- Conflict resolution
- Ability to represent the organization in the community
PREFERRED COMPETENCIES
Preferred Job Skills
- Advanced PC proficiency
- Knowledge of CPT 2018 and ICD-10 coding
Preferred Professional Competencies
- Knowledge of managed care, utilization management, and quality management
- Familiarity with InterQual, MCG, ASAM, or similar criteria tools
- Understanding of organizational services and operations
- Knowledge of patient education and behavior change techniques
Preferred Leadership Competencies
- None
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
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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