Hybrid RN Utilization Review Auditor - High-Cost Claims
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona is looking for a Clinical Analyst to assess member utilization and predict future healthcare spending. The successful candidate will collaborate with multidisciplinary teams to enhance customer relationships and service, while also identifying clinical opportunities to improve member outcomes. Candidates should have a minimum of 5 years of experience in healthcare, with specific qualifications as an RN analyst in Utilization Review or Care Management. This position promotes a hybrid work environment, emphasizing flexibility and teamwork. #J-18808-Ljbffr Blue Cross Blue Shield of Arizona
- ...AZ Blue, we have a hybrid workforce strategy,... ...: Customer Service, Claims Processors, and Correspondence... ...of member utilization and prediction of future... ...resource to review High Cost Claimants to identify... ...years’ experience as an RN analyst or auditor in Utilization Review...ClaimsFull timeWork experience placementRemote work1 day per week
- ...At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...PURPOSE OF THE JOB The Utilization Review Supervisor coordinates... ...timeliness standards, cost effectiveness, and regulatory... ...a Registered Nurse (RN) Required...ClaimsFull timeWork experience placementRemote work2 days per week1 day per week
- ...Blue, we have a hybrid workforce... ...Customer Service, Claims Processors, and... ...clinical audits and reviews to ensure... ...study or Post High School Nursing... ...Registered Nurse (RN) or Master’s in... ...Manager (CCM) or Utilization Management Certification... ...medical costs and improving...ClaimsRemote jobFull timeWork experience placement1 day per week
- At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...field of study, or post high school nursing diploma... ...concerns. Conduct clinical review of complaints received... ...Knowledge of managed care, utilization management, and quality...ClaimsFull timeWork experience placementWork at officeRemote work1 day per week
- Blue Cross Blue Shield of Arizona is seeking a Utilization Review Supervisor in Phoenix, AZ. This hybrid role requires coordination of medical necessity reviews and... ...have 2 years of clinical experience and an active RN license in Arizona. The position entails evaluating...Suggested
$29.05 - $67.97 per hour
...seeking a clinical nurse to oversee the medical review process, ensuring claims and records meet necessary guidelines. The... .... Applicants must possess an active RN license and have experience in clinical nursing and utilization review. Additionally, familiarity with coding...ClaimsHourly pay- Physical Therapy Utilization Review Advisor PRIMARY PURPOSE Counsels providers (physical therapists... ...health needs; and promotes quality cost-effective physical therapy outcomes. ARE... ...Sedgwick clinical team on difficult claims and provides recommendations tied to improving...ClaimsWork at office
$29.05 - $67.97 per hour
...Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate... ...the medical record and claim submitted support correct coding... ...and experience. Registered Nurse (RN). License must be active and...ClaimsHourly payWork experience placementWork at office$71.1k - $97.8k
...The Inpatient Medical Coding Auditor extracts clinical... ...medical coding auditor to review inpatient hospital claims for proper reimbursement, handle... ...Auditor contributes to overall cost reduction, by increasing the... ...will provide Home or Hybrid Home/Office associates with...ClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...health decisions. Hybrid Workforce Strategy... ...Customer Service, Claims Processors, and... ...activities related to utilization management, case... ...quality of care, lower costs, and align with... ..., and procedures; review noncompliance and... ...of our members, high-quality patient care...ClaimsWork at officeRemote work1 day per week
- Turo Inc. is seeking a Claims Specialist to handle high-complexity claims, requiring analysis of policies and customer communication. This role involves... ...strong investigative skills and independent judgment. A hybrid work model is offered, alongside competitive salary and...Claims
- An established industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix. This role involves reviewing and adjudicating medical claims, ensuring compliance with industry standards, and working collaboratively with healthcare providers. The...ClaimsRemote work
- ...At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...field of study or Post High School Nursing Diploma... ...professional, including RN, LPN, LPT, LBSW, LMSW,... ...claims retrospective review, utilization management, case management...ClaimsRemote jobWork experience placement1 day per week
- ...AZ Blue, we have a hybrid workforce strategy,... ...Customer Service, Claims Processors, and Correspondence... ...promoting quality, cost effective outcomes.... ...of study or Post High School Nursing... ...(NLC) as an RN, or active registration... ...management, managed care, utilization management, and...ClaimsRemote jobFull timeContract workWork experience placementWork at office1 day per week
- ...is offering a remote internship opportunity for a Utilization Management Behavioral Health Registered Nurse (RN). This role is part of the DOW SkillBridge Internship... ...military spouses. Interns will conduct clinical reviews, communicate with providers, and document findings...InternshipRemote work
$88k - $145k
...informed insights. In this hybrid role, you will focus on... ...We ask you to have a high level of analytical... ...insights and creating cost benefit analysis using... ...encouraged to apply and should review the internal mobility... ...in pricing/actuarial, claims, etc. to ensure product...ClaimsFull timeContract workWork at officeLocal area- ....At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...JOBLead Segment specific cost of care efforts in identification... ...optimize the cost of high-quality medical care... ...patterns in Segment utilization across provider panels,...ClaimsFull timeWork at officeRemote workShift work1 day per week
$35 - $40 per hour
...Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating... ...patients’ needs, ensuring efficient, cost-effective, and compliant delivery of... ...nursing. Current, active nursing license (RN, LPN, or LVN) in good standing with the...Contract workRemote workFlexible hoursWeekend work$140k - $180k
...We’re seeking a Cost Controls Manager to support large... ...full‑time, long‑term, hybrid position (2‑3 days per... .... Lead monthly cost reviews with owner leadership,... ...practices. Contribute to claims defense and forensic analyses... ...rail and bus), utilities, and/or airport projects...ClaimsFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours2 days per week3 days per week$63.59k - $114.45k
...as you manage complex property insurance claims primarily via telephone. Candidates should... ...have 2 years of adjusting experience, a high school diploma, and knowledge of Xactimate... ...ranges from $63,590 to $114,450, with a hybrid work schedule and comprehensive benefits...Claims$35 per hour
....00/hr - $35.00/hr Medical Review Nurse Location: Phoenix, AZ... ...Emergency Services (FES) 1500 claim forms. Some coordination will... ...protocols, quality management and utilization review protocols as related to... ...Requirements: • Active RN License in state of Arizona...ClaimsHourly payContract workTemporary workPart timeFor contractorsWork at officeRemote workShift workDay shift$43.89k - $85.07k
...to join their specialized Pharmacy Audit division. This role entails conducting compliance audits and verifying pharmacy-submitted claims related to Medicare, ensuring adherence to CMS standards. The ideal candidate will possess strong communication skills and familiarity...ClaimsFull time- ...At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...) Required Education High‑School Diploma or GED in... ...Responsibilities Level 1 Write and review business requirements,... .../external customers Utilize problem‑solving skills...ClaimsFull timeWork experience placementRemote work1 day per week
- The Utility Development Project Engineer will support... ...projects.Support budgets and cost forecasting of utility... ...commissioning services.Review monthly pay... ...or more years of medium/high voltage construction management... ...or discrimination claim.The "Know Your Rights"...ClaimsFor contractorsWork at officeFlexible hours
- ...Arizona Health Care Cost Containment System... ...recognized for its high employee engagement... ...Informatics & Prepayment Review Health Consultant... ...directly to the Claims Operations... ...data management, and utilization review regulations,... ...Arizona medical license (RN or higher) or Arizona...ClaimsFull timeWork at officeRemote workFlexible hours
$34.8k
...service platform. Our claims and risk engineering services... ...to work with a high-quality team of leaders... ...handling. This role is hybrid for our Scottsdale, AZ... ...supporting documentation for review by the Claims Examiner... ...relevant cases to the Cost Containment team Maintain...ClaimsWork at officeRemote work$110.45k - $138.06k
## EPC Project Manager, Utility Scale Solar (Tonopah,... ...solar, battery storage and high voltage substation... ...of aged receivables and review their status regularly... ...resolution.* Negotiate cost-effective subcontract and... ...SSQMP)* Avoid or mitigate claims and conflict* Complete...ClaimsFull timeContract workFor subcontractorLocal areaRemote work- ...SUMMARY The Prior Authorization RN is responsible for reviewing and processing medical... ...role in supporting cost-effective care while ensuring... ...related to prior authorization, utilization management, and/or case... ...review experience is highly preferred Experience with...
- ...state of Arizona. Hybrid Workforce... ...Customer Service, Claims Processors, and Correspondence... ...accrediting body reviews. Responsible for... ...registered nurse (RN). Preferred... ...Analytics to analyze utilization and identify opportunities... ...of the costs/quality challenges...ClaimsFull timeWork at officeRemote work2 days per week1 day per week
- ...At AZ Blue, we have a hybrid workforce strategy, called... ...to: Customer Service, Claims Processors, and... ...years Required Education High‑School Diploma or GED in... ...Participate in the development, review, and creation of... ...review. Develop time and cost estimates and system...ClaimsFull timeTemporary workWork experience placementRemote workAfternoon shift1 day per week
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