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Nurse Auditor, High-Cost Claimant Review Unit
Blue Cross Blue Shield of ArizonaRN Auditor responsible for assessing member utilization and collaborating on improvement strategies. Working remotely in Arizona to enhance patient outcomes and resource utilization.
About the role
Key responsibilities & impact- Function as a designated clinical resource to review High Cost Claimants to identify opportunities to improve member outcomes and determine correct utilization of resources
- Collaborate with multi-disciplinary teams to determine if there are other resources, BCBSAZ programs, or community resources that can curtail benefit spend or improve outcomes
- Focus on enhancing customer relationship and service as the primary clinical point of contact
Requirements
What you’ll need- 5 years of experience working within a healthcare and/or management care
- 2 consecutive years’ experience as an RN analyst or auditor in Utilization Review, Medical Claim Review and/or Care Management
- Active, unrestricted license to practice as a registered nurse (RN) in the state of Arizona
Benefits
Comp & perks- Health insurance
- Flexible work arrangements
- Professional development opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Clinical Resource ReviewHigh Cost Claimant AnalysisOutcome Improvement StrategiesBenefit Spend ManagementData Analysis
Soft Skills
CollaborationCustomer Relationship ManagementCommunication
Certifications
Active RN License in Arizona