BCBSAZ
High-Cost Claimant Review Unit Nurse Auditor (Remote in AZ)
AZ Blue Phoenix, AZ 85021 · Full-time
Sponsorship not specifiedDetected 22 days ago
Data AnalysisProject ManagementAccount ManagementBudgetingProcess ImprovementCustomer SupportLeadershipCommunication
About the role
- Our positions are classified as hybrid, onsite or remote.
- This position is remote within the state of AZ only.
- This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Responsibilities
- Refer the member to appropriate internal BCBSAZ group to manage and coordinate care as indicated.
- Lead process improvement initiative and projects to improve the delivery of services.
- Develop relationships and establish credibility with key stakeholders (internal and external) to achieve solution strategies and objectives. Routinely collaborate with account management team to provide clinical aspects of High Cost Claimant reviews.
- Support clinical quality audit activities under the direction of manager to identify opportunities to deliver on commitments and enhance customer satisfaction/experience.
- Maintain effective working relationships to ensure teamwork in achieving company goals.
- Foster effective communication with business partners by setting clear directives and providing exchange of ideas.
- Effectively communicates analytical and reporting needs to supporting departments. Identify and create opportunities to manage trend(s).
- Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
- Perform other duties as assigned.
Requirements
- Associate's Degree in Nursing or related field of study
- Required Work Experience
Nice to have
- 3 years' experience with managing direct customer facing or account management experience
- Experience with working with VITAL, Metavance and/or Guiding Care platforms
- Experience in operational analysis, data analysis and problem resolution types of activities
- Bachelor's or Master's Degree in Nursing or related field of study
- Certified Commission of Case Managers
- PMP Certification or Six Sigma/Lean Project Management
- Preferred Work Experience
- Preferred Licenses
Benefits
- Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
- Apply knowledge of customer benefit structure to determine appropriate use of services.
- Collaborate with multi-disciplinary team to determine if there are other resources; BCBSAZ programs, community resources that can curtail benefit spend or improve outcomes.
- Continue to evaluate the member's benefit spend according to Key Decision Criteria.
- Responsible for the professional, efficient and timely delivery of services to members and customer/Group Benefit Administrator requesting assistance.
- Represent customer-internally and coordinate with other departments such as medical and pharmacy account team to address ongoing needs, implement care initiatives, projects and customer systems.
- Able to analyze and interpret benefit designs and identify opportunities to increase efficiency.
- Provide leadership on change management principles to ensure maximize benefit and alleviate unnecessary disruption.
Company info
- Document findings in a manner that can be consumed by internal process for reporting purposes, internal and external customers.
- 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.