BCBSAZ
BH UM Clinical Reviewer- Remote AZ
AZ Blue Phoenix, AZ 85021 · Full-time
Sponsorship not specifiedDetected 21 days ago
Customer SupportICD-10ResearchLeadershipCommunicationProblem SolvingOrganizational Skills
About the role
- Our positions are classified as hybrid, onsite or remote.
- This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
- This job description is primary for utlization management functions but can assist with care management if a business need arises.
Responsibilities
- Collaborate with team to distribute workload/work tasks.
- Support/mentor team members.
- Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
- Perform all other duties as assigned.
- Maintain confidentiality and privacy
- Navigate, gather, input and maintain data records in multiple system applications
Requirements
- Required Work Experience
- Required Licenses
- Required Certifications
- Intermediate PC proficiency
- 2 year(s) of experience in clinical field of practice, health insurance, or other health care related field
- Required Education
- Associate's Degree in general field of study or Post High School Nursing Diploma or Master's Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D.
- Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.
- 3 year(s) of experience in clinical field of practice, health insurance, or other health care related field
- Preferred Education
Nice to have
- 1-2 year (s) of experience working in a managed care organization
- Bachelor's Degree in Nursing or related field of study
- Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
- Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
- 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.
- Demonstrate ability to apply plan policies and procedures effectively.
- Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
- Preferred Work Experience
Compensation
- Participate in continuing education and current developments in the fields of medicine, behavioral health and managed care at least annually.
Benefits
- Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
- Participate in continuing education and current developments in the fields of medicine, behavioral health and managed care at least annually.
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.