Registered Nurse – Precertification Lead; remote

Industry: Private

Employment Type:

Full Time

Work Hours:

8 Hours

Locations: USA

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Assists the Manager, Care Management-Precertification with performing duties to oversee day-to-day activities within the Care Management-Precertification Department to facilitate the achievement of business goals and targets. Support management with leading Precertification team to ensure all types of precertification cases are completed in compliance with State, Federal, accreditation standards and other applicable regulations.

• Required Work Experience
• 5 year(s) of experience in clinical field of practice, health insurance or other health care related field
• Required Education
• Associate's Degree or Diploma in Nursing
• Required Licenses
• Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN) current, and unrestricted State of Registered Nurse license
• Required Certifications
• N/A

• Preferred Work Experience
• 3 year(s) of experience in clinical field of practice, health insurance, or other health care related field
• 1 year(s) experience in a lead role
• Preferred Education
• Bachelor's Degree in Nursing or business related field of study
• Master's Degree in Nursing or business related field of study
• Preferred Licenses
• N/A
• Preferred Certifications
• N/A

• Assist with the development and review of l key workflows, policies and procedures and job aids at least annually.
• Under the direction of the Manager, Care Management-Precertification updates/revises workflows, policies and procedures and job aids as needed.
• Assist with assigning work queues and oversight for key performance indicators
• Oversee day-to-day activities, including inventory management to meet departmental and corporate timeliness standards
• Assist with improving the 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
• Maintain a thorough knowledge of evidence-based criteria and other policies
• Assist with the validation and confirmation of follow through of the medical review decisions.
• Assist with the development, execution and evaluation of desk level procedures and job aids
• Assist with the reviewing, updating and accurate documentation, computer files, policies and procedures related to the departmental goals and objectives.
• Assist with maintaining all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
• Assist with the implementation of quality assurance process, procedures, and measure for team activities.
• Assist with providing motivation and encouragement to team.
• Assist with interviews and candidate selection
• Performs all other duties as assigned
• Assist leadership with deployment of strategic initiatives and Perceptyx plan.
• 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.

• Required Job Skills Strong written and verbal communications. Excellent organizational skills and strong attention to detail
• Possess proficient computer and technological skills especially Word, Excel,…