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Blue Cross Blue Shield of Arizona

Nurse Auditor, High-Cost Claimant Review Unit

Blue Cross Blue Shield of Arizona

RN Auditor responsible for assessing member utilization and collaborating on improvement strategies. Working remotely in Arizona to enhance patient outcomes and resource utilization.

Posted 7/1/2026full-timePhoenix • Arizona • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit
Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Review, Medical Claim Review, and Care Management, with a strong focus on improving member outcomes and managing healthcare resources effectively. Proven ability to collaborate with multi-disciplinary teams and enhance customer relationships as a clinical resource.

Highest-signal resume keywords
Utilization ReviewMedical Claim ReviewCare ManagementRegistered Nurse (RN) LicenseHealthcare Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Clinical Resource ReviewHigh Cost Claimant AnalysisOutcome Improvement StrategiesBenefit Spend ManagementData Analysis
Soft Skills
CollaborationCustomer Relationship ManagementCommunication
Certifications & Qualifications
Active RN License in Arizona
Industry Keywords
HealthcareManaged CareMulti-Disciplinary TeamsResource 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