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Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona

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🔥 Prior Authorization Nurse - Medicaid (Remote)
Posted 2024-11-19

📍 United States of America

🧭 Full-Time

🔍 Health insurance

  • Requires 3 years of clinical experience.
  • Requires 1 year of Medicaid/Medicare experience.
  • Requires 1 year of prior authorization and member/provider notification (NOA) experience.
  • Requires 1 year of experience with National Committee for Quality Assurance (NCQA) standards.
  • Requires an Associate degree in Nursing.
  • Requires an active, current, and unrestricted license to practice in the State of Arizona as an RN or LPN.

  • Ensures the accuracy and timeliness of prior authorization requests to meet contractual requirements.
  • Coordinates and manages the established preauthorization review process for pre-service requests.
  • Ensures the use of nationally recognized and evidence-based standards in the completion of all pre-service reviews.
  • Utilizes clinical skills, chart review, physician communication, and appropriate criteria for approval of pre-service requests; escalates requests to the medical director when criteria are not met.
  • Documents review rationale to support approval and Notice of Action.
  • Initiates interdepartmental coordination to ensure quality care for members.
  • Participates in Quality Improvement Projects as directed.
  • Engages cross-functionally in special projects as needed.
  • Performs Notice of Action process and participates in policy reviews.
  • Works full-time, 40 hours per week, with additional hours as needed.

Data AnalysisData analysisCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelProblem SolvingMicrosoft OfficeAttention to detailOrganizational skillsTime ManagementWritten communicationMultitaskingDocumentationMicrosoft Office Suite

Posted 2024-11-19
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🔥 Health Risk Assessment Nurse (Remote - AZ)
Posted 2024-11-19

📍 Arizona

🧭 Full-Time

🔍 Health Insurance

  • 2 years nursing experience in a health care setting.
  • Associate’s Degree in Nursing field of study.
  • Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN) or Practice Nurse (LPN).

  • Complete both initial and annual Health Risk Assessments.
  • Utilize risk stratification tools to classify members as low, medium, or high acuity.
  • Work collaboratively with the member to create individualized care plans based on Health Risk Assessment data, chronic conditions, and gaps in care.
  • Ensure individualized care plans are time sensitive and contain measurable goals.
  • Collaborate with the Interdisciplinary Care Team to incorporate best practices, assess outcomes, and develop individualized care plans.
  • Ensure the member and all members of the Interdisciplinary Care Team receive a copy of the individualized care plan to ensure continuity of care.
  • Educate members on preventive measures and regular follow-ups with their primary care provider.
  • Identify members who would benefit from management programs and make necessary referrals.
  • Identify gaps in care and address them with the member.
  • Document all work in the care management system per CMS timelines.

Communication SkillsAnalytical SkillsCollaborationProblem SolvingCustomer serviceAttention to detailOrganizational skillsPresentation skillsTime ManagementWritten communicationMultitaskingDocumentation

Posted 2024-11-19
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🔥 Transition of Care Nurse (remote - AZ)
Posted 2024-11-19

📍 Arizona

🧭 Full-Time

🔍 Health Insurance

  • 2 years Nursing experience in a health care setting.
  • Associate’s Degree in Nursing.
  • Registered Nurse with a current, active, unrestricted nursing license in the state of Arizona.
  • Strong knowledge of care management and care coordination.
  • Proficiency in computer and technology utilization including care management software and Microsoft Office Products (Outlook, Excel, Power Point, Word, Visio).
  • Effective written and verbal communication skills.

  • Telephonic contact with the members within 3 days of discharge.
  • Facilitate completion of all discharge orders that have not been completed.
  • Complete TOC surveys.
  • Complete LACE tool.
  • Obtain data needed for Medication Reconciliation.
  • Follow up with member up to 30 days post discharge based on LACE tool scoring.
  • Perform all other duties as assigned.

Communication SkillsAnalytical SkillsCollaborationMicrosoft ExcelProblem SolvingCustomer serviceMicrosoft OfficeAttention to detailOrganizational skillsPresentation skillsTime ManagementWritten communicationMultitaskingDocumentationMicrosoft Office Suite

Posted 2024-11-19
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