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Remote: not held to onsite requirements, however, leadership can request presence onsite for ... Registered Nurse (RN) Required Certifications * N/A PREFERRED QUALIFICATIONS Preferred Work ...
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Phoenix, AZ · On-site +1
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Initial Clinical Reviewer - Remote - AZ
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This is a full-time, remote opportunity working Monday-Friday, 8am-5pm. Must reside in Maricopa or Pinal County.* The Workflow Specialist (RN) is responsible for coordinating and managing key ...
Quick apply
This is a full-time, remote opportunity working Monday-Friday, 8am-5pm. Must reside in Maricopa or Pinal County.* The Workflow Specialist (RN) is responsible for coordinating and managing key ...
This is a full-time, remote opportunity working Monday-Friday, 8am-5pm. Must reside in Maricopa or Pinal County.* The Workflow Specialist (RN) is responsible for coordinating and managing key ...
This is a full-time, remote opportunity working Monday-Friday, 8am-5pm. Must reside in Maricopa or Pinal County.* The Workflow Specialist (RN) is responsible for coordinating and managing key ...
Adjunct - Advanced Pathophysiology and Pharmacology for Nurse Educators- Online (Remote) - College o
Phoenix, AZ · On-site +1
Adjunct - Advanced Pathophysiology and Pharmacology for Nurse Educators- Online (Remote) - College ... Nurses must maintain an active, current, unrestricted and unencumbered AZ or Multi-state RN license ...
Adjunct - Advanced Pathophysiology and Pharmacology for Nurse Educators- Online (Remote) - College o
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Adjunct - Advanced Pathophysiology and Pharmacology for Nurse Educators- Online (Remote) - College ... Nurses must maintain an active, current, unrestricted and unencumbered AZ or Multi-state RN license ...
This is a full-time, remote opportunity working Monday-Friday, 8am-5pm. Must reside in Maricopa or Pinal County.* The Workflow Specialist (RN) is responsible for coordinating and managing key ...
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Care Manager (RN) Remote (Must Reside In AZ)
Phoenix, AZ · On-site +1
$26.41 - $51.49/hr
This RN will act as a Care Manager supporting our AZ Medicaid members who have recently been admitted to this hospital. The Medicaid Care Manager will support them to ensure a successful transition ...
Care Manager (RN) Remote (Must Reside In AZ)
Phoenix, AZ · On-site +1
$26.41 - $51.49/hr
This RN will act as a Care Manager supporting our AZ Medicaid members who have recently been admitted to this hospital. The Medicaid Care Manager will support them to ensure a successful transition ...
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 ...
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 ...
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Utilization Review Nurse
Tempe, AZ · Remote
$35 - $45.94/hr
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$83K - $109K/yr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... Licensed Registered Nurse with active, unrestricted license in state of residence and willingness ...
Quick apply
Sr. Quality of Care Review Nurse
Tempe, AZ · Remote
$83K - $109K/yr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... Licensed Registered Nurse with active, unrestricted license in state of residence and willingness ...
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$250K - $500K/yr
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Psych Nurse Practitioner (PMHNP, Psych APRN)
Phoenix, AZ · Remote
$250K - $500K/yr
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... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... Exercise complete control over your professional practice by designing a schedule that aligns with ...
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... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... Exercise complete control over your professional practice by designing a schedule that aligns with ...
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... Exercise complete control over your professional practice by designing a schedule that aligns with ...
... Psychiatric Mental Health Nurse Practitioners (PMHNP). In this remote, independent contract ... Exercise complete control over your professional practice by designing a schedule that aligns with ...
Adjunct - Nursing Education Practicum - Online (Remote) - College of Nursing and Health Care Profess
Phoenix, AZ · On-site +1
... RN license. * Three years professional experience required. * Strong communication skills and the ability to build supportive relationships with students * Proficiency in English, grammar, and APA ...
Adjunct - Nursing Education Practicum - Online (Remote) - College of Nursing and Health Care Profess
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... RN license. * Three years professional experience required. * Strong communication skills and the ability to build supportive relationships with students * Proficiency in English, grammar, and APA ...
Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
Phoenix, AZ · Remote
$180K - $215K/yr
Control over their schedule, session structure, and patient population * Minimal administrative ... Board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) * Active, unrestricted ...
Quick apply
Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
Phoenix, AZ · Remote
$180K - $215K/yr
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Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
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Control over their schedule, session structure, and patient population * Minimal administrative ... Board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) * Active, unrestricted ...
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Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
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Control over their schedule, session structure, and patient population * Minimal administrative ... Board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) * Active, unrestricted ...
Quick apply
Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
Scottsdale, AZ · Remote
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Control over their schedule, session structure, and patient population * Minimal administrative ... Board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) * Active, unrestricted ...
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Quick apply
Remote Psychiatric Nurse Practitioner (PMHNP) - Arizona
Mesa, AZ · Remote
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Control over their schedule, session structure, and patient population * Minimal administrative ... Board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) * Active, unrestricted ...
Clinical Trainer and Auditor - Utilization Management Experience - Remote-AZ
Phoenix, AZ · On-site +1
... an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an ... Develop, maintain, version control for training materials, job aids, facilitator guides, and ...
Clinical Trainer and Auditor - Utilization Management Experience - Remote-AZ
Phoenix, AZ · On-site +1
... an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an ... Develop, maintain, version control for training materials, job aids, facilitator guides, and ...
... an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an ... Develop, maintain, version control for training materials, job aids, facilitator guides, and ...
... an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an ... Develop, maintain, version control for training materials, job aids, facilitator guides, and ...
Remote Rn Poison Control information
See Glendale, AZ salary details
$34.8K - $45.9K
7% of jobs
$45.9K - $57K
6% of jobs
$57K - $68.2K
5% of jobs
$75.8K is the 25th percentile. Wages below this are outliers.
$68.2K - $79.3K
9% of jobs
$79.3K - $90.4K
16% of jobs
The median wage is $96K / yr.
$90.4K - $101.5K
13% of jobs
$101.5K - $112.6K
12% of jobs
$118.2K is the 75th percentile. Wages above this are outliers.
$112.6K - $123.8K
14% of jobs
$123.8K - $134.9K
7% of jobs
$134.9K - $146K
10% of jobs
$146K - $157.1K
1% of jobs
$34.8K
$98.4K
$157.1K
How much do remote rn poison control jobs pay per year?
What is a remote RN poison control?
What are some common challenges remote RN poison control nurses face, and how can they effectively manage them?
What are the key skills and qualifications needed to thrive as a remote RN poison control?
What are the most commonly searched types of Rn Poison Control jobs in Glendale, AZ?
The most popular types of Rn Poison Control jobs in Glendale, AZ are:
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For Remote Rn Poison Control jobs in Glendale, AZ, the most frequently searched job titles are:
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The top searched job categories for Remote Rn Poison Control jobs in Glendale, AZ are:
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Cities near Glendale, AZ with the most Remote Rn Poison Control job openings:

Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote
Phoenix, AZ • On-site, Remote
Full-time
Medical
This job post has expired today. Applications are no longer accepted.
Blue Cross Blue Shield Of Arizona rating
5.9
Based on 13 frontline employees who took The Breakroom Quiz
290th of 308 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 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.
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