BCBSAZ
Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote
AZ Blue Phoenix, AZ 85021 · Mid · Full-time
Sponsorship not specifiedDetected 30 days ago
Customer SupportICD-10ResearchLeadershipCommunicationProblem SolvingOrganizational Skills
About the role
- Our positions are classified as hybrid, onsite or remote.
- This position is remote within Arizona or in an approved out-of-state location.
- Working knowledge of eviCore, MCG, McKesson InterQual® criteria and Medical Coverage Guidelines/Medical Policies.
Requirements
- Required Work Experience
- 1 year Experience in clinical and health insurance or other healthcare related field
- 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)
- 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)
- 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)
Nice to have
- Bachelor's Degree in Nursing or related field of study (Applies to All Levels)
- Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
- 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.
- Preferred Work Experience
- Preferred Licenses
- Preferred Certifications
- ESSENTIAL job functions AND RESPONSIBILITIES
- Demonstrate ability to apply plan policies and procedures effectively.
Compensation
- 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, W
Benefits
- Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
Company info
- At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
This listing is sourced directly from BCBSAZ's careers page and normalized into a canonical job model.