Top 1270 Quality improvement nurse Jobs in Phoenix, Az

BH UM Clinical Reviewer- Remote AZ
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Mid-level
- Organizational skills
- 1 year
Clinical Quality Reviewer - REMOTE - RN - US Citizen Required
TEEMA —Phoenix, AZ
- $41 - $44 an hour
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
Quick Apply
Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required
TEEMA —Phoenix, AZ
- $41 - $44 an hour
- Full-time
- Remote
- Nursing
- Surgery
- RN License
Quick Apply
Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Mid-level
- 1 year
- Leadership
MDS Nurse
Freedom Plaza a Sun Health Community —Peoria, AZ
- From $40 an hour
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Nurse Practitioner / Physician Assistant HRT
IntraCare Health Center —Phoenix, AZ
- Up to $150,000 a year
- Full-time
- Mid-level
- Clinic
- 2 years
- Health insurance
- Dental insurance
Quick Apply
Neonatal Nurse Practitioner
Pediatrix —Phoenix, AZ
- Full-time
- Hybrid work
- Mid-level
- Master's degree
- Children
- Employee stock purchase plan
- Health insurance
Registered Nurse - Orthopedic Med Surg & Extended Recovery - Night Shift
the CORE Institute | HOPCo —Phoenix, AZ
- Night shift
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Quick Apply
Occupational Therapist
Resolve Harmony Center —Phoenix, AZ
- $49 - $53 an hour
- Full-time
- School experience
- Experience working with individuals with developmental disabilities
- Anatomy knowledge
- Health insurance
- Dental insurance
Quick Apply
Telehealth Nurse Practitioner
Gracey Care AZ, P.C. —Arizona
- $55 - $80 an hour
- Choose your own hours
- Remote
- Nursing
- Doctoral degree
- Certified Nurse Practitioner
- Work from home
- Flexible schedule
Quick Apply
Registered Nurse - Orthopedic Med Surg & Extended Recovery / Observation Unit - Day Shift
the CORE Institute | HOPCo —Phoenix, AZ
- Day shift
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Quick Apply
Nurse Practitioner
Comprehensive Rehab Consultants —Glendale, AZ
- $112,000 - $132,000 a year
- 8 hour shift
- Skilled nursing facility
- Physical & Rehabilitation Medicine
- Mid-level
- Continuing education credits
- Disability insurance
Quick Apply
5d
Infusion Center Nurse Practitioner
AIS Healthcare —Phoenix, AZ
- Full-time
- CPR Certification
- Nursing
- BLS Certification
Quick Apply
Registered Nurse (RN)
GARDAWORLD FEDERAL SERVICES LLC —Surprise, AZ
- $46.00 - $51.09 an hour
- Weekends as needed
- Background check
- CPR Certification
- Nursing
Quick Apply
Medical Director - Physician
Desert Oazis LLC —Scottsdale, AZ
- $150 - $1,500 an hour
- Contract
- Hybrid work
- Medicine
- Management
- Primary Care
- Professional development assistance
- Flexible schedule
Quick Apply
CVOR Surgical Tech - $10,000 Sign-on Bonus
HonorHealth —Scottsdale, AZ
- Full-time
- Surgery
- BLS Certification
- High school diploma or GED
- Free parking
- Health insurance
Nurse Supervisor Cardiac Cath Lab - FT Days
HonorHealth —Scottsdale, AZ
- Full-time
- Nursing
- Skilled nursing facility
- RN License
RN Supervisor Telemetry Days - Tempe
HonorHealth —Tempe, AZ
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Veterinary Technician Supervisor (Charge Nurse) Overnight
Arizona Veterinary Emergency & Critical Care Center —Gilbert, AZ
- $29 - $36 an hour
- Overnight shift
- Customer service
- Mid-level
- Operating room
- Health savings account
- Health insurance
Quick Apply
Registered Nurse RN Peoria
Optum —Peoria, AZ
- $43.53 - $65.29 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply

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quality improvement nurse jobs near phoenix, az

BH UM Clinical Reviewer- Remote AZ

Blue Cross Blue Shield of Arizona -
Phoenix, AZ

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Job Details

Full-time

Qualifications

Mid-level
Organizational skills
1 year
Leadership
Communication skills

Full Job Description

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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

Responsible for identifying, researching, processing, resolving and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry. This job description is primary for utlization management functions but can assist with care management if a business need arises.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

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.

Required Licenses

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.

Required Certifications

PREFERRED QUALIFICATIONS

Preferred Work Experience

3 year(s) of experience in clinical field of practice, health insurance, or other health care related field
1-2 year (s) of experience working in a managed care organization

Preferred Education

Bachelor's Degree in Nursing or related field of study

Preferred Licenses

Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse

Preferred Certifications

ESSENTIAL job functions AND RESPONSIBILITIES

Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
Answer a diverse and high volume of health insurance related customer calls or correspondence daily.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Maintain complete and accurate records per department policy.
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.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
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.
When indicated to assist with team/project functions:
- Collaborate with team to distribute workload/work tasks.
- Monitor and report team tasks.
- Communicate team issues and opportunities for improvement to supervisor/manager;
- Support/mentor team members.
Participate in continuing education and current developments in the fields of medicine, behavioral health and managed care at least annually.
Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned.

competencies

REQUIRED COMPETENCIES

Required Job Skills

Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones

Required Professional Competencies

Maintain confidentiality and privacy
Strong current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Compose a variety of business correspondence
Interpret and translate policies, procedures, programs and guidelines
Capable of investigative and analytical research
Navigate, gather, input and maintain data records in multiple system applications
Follow and accept instruction and direction
Establish and maintain working relationships in a collaborative team environment
Organizational skills with the ability to prioritize tasks and work with multiple priorities
Independent and sound judgment with good problem solving skills

Required Leadership Experience and Competencies

Resolve conflicts
Represent BCBSAZ in the community

PREFERRED COMPETENCIES

Preferred Job Skills

Advanced PC proficiency
Knowledge of CPT 2018 and ICD-10 coding

Preferred Professional Competencies

Knowledge of managed care, utilization management, and quality management
Working knowledge of McKesson InterQual® criteria, MCG, ASAM, or other nationally recognized criteria

Preferred Leadership Experience and Competencies

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

Apply Now

Refine Your Search

quality improvement nurse jobs in phoenix, az

BH UM Clinical Reviewer- Remote AZ

Clinical Quality Reviewer - REMOTE - RN - US Citizen Required

Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required

Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

MDS Nurse

Nurse Practitioner / Physician Assistant HRT

Neonatal Nurse Practitioner

Registered Nurse - Orthopedic Med Surg & Extended Recovery - Night Shift

Occupational Therapist

Telehealth Nurse Practitioner

Registered Nurse - Orthopedic Med Surg & Extended Recovery / Observation Unit - Day Shift

Nurse Practitioner

Infusion Center Nurse Practitioner

Registered Nurse (RN)

Medical Director - Physician

CVOR Surgical Tech - $10,000 Sign-on Bonus

Nurse Supervisor Cardiac Cath Lab - FT Days

RN Supervisor Telemetry Days - Tempe

Veterinary Technician Supervisor (Charge Nurse) Overnight

Registered Nurse RN Peoria

I want to receive the latest job alert for quality improvement nurse in phoenix, az

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