RN Initial Clinical Reviewer

🔥 12 hours ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Blue Cross Blue Shield of Arizona

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Blue Cross Blue Shield of Arizona is a health insurance provider offering a variety of health plans tailored to individuals, families, employers, and Medicare recipients. With a commitment to improving healthcare access and community health, AZ Blue provides self-insured and ACA-compliant health plans, including Medicare Advantage and Medicaid options. The organization focuses on connecting members with care through its extensive network, aiming for better health outcomes and community support.

📋 Description

• Identify, research, process, resolve, and respond to customer inquiries and correspondence via telephone, written communication, and/or in person • Answer a diverse and high volume of health insurance-related customer calls or correspondence daily • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine appropriateness of benefit requests • Maintain complete and accurate records according to department policy • Meet quality, quantity, and timeliness standards for individual and department performance goals • Explain organizational services, contract benefits, coverage changes, eligibility, claims, BCBSAZ programs, and provider networks to customers • Apply plan policies and procedures effectively • Consult and coordinate with internal departments, external plans, providers, businesses, and government agencies to resolve customer inquiries • Collaborate on team/project functions, distribute workload, monitor and report tasks, communicate issues and improvement opportunities, and support or mentor team members • Participate in continuing education and current developments in medicine and managed care • Maintain compliance with State, Federal, BCBSAZ, and accreditation requirements • Perform other duties as assigned

🎯 Requirements

• 2 years of experience in clinical field of practice, health insurance, or other health care related field • Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program • Active, current, and unrestricted Arizona license (or endorsement) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.); OR active, current, and unrestricted RN license in Arizona or another NLC state; OR active, current, and unrestricted Arizona LPN license • Intermediate PC proficiency • Intermediate skill using office equipment, including copiers, fax machines, scanners, and telephones • Maintain confidentiality and privacy • Strong current clinical knowledge • Interpersonal and active listening skills • Ability to compose business correspondence • Ability to interpret and translate policies, procedures, programs, and guidelines • Investigative and analytical research skills • Ability to navigate, gather, input, and maintain data records in multiple system applications • Ability to follow and accept instruction and direction • Ability to establish and maintain collaborative working relationships • Organizational skills and ability to prioritize multiple tasks • Independent judgment and problem-solving skills

🏖️ Benefits

• Hybrid workforce strategy (Workability) offering flexibility with how and where employees work • Remote work opportunity with no routine onsite requirement • Full-time schedule of at least 40 hours per week • Continuing education and participation in current developments in medicine and managed care