Prior Authorization reputed company - reputed company (AZ Remote)

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company.At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements:

• Hybrid People Leaders: must reputed company in AZ, required to be onsite at least once per week
• Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company 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 reputed company 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 reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.This position is remote reputed company the state of AZ onlyPURPOSE OF THE JOBUnder the direction of the Prior Authorization Management (PA), ensures prospective review/prior authorization requests arecompleted in a reputed company fashion to meet contractual requirements and ensures reputed company reviews are conducted using nationallyrecognized and evidence-based standards.QualificationsREQUIRED QUALIFICATIONS

• Required Work Experience
• 2 years of clinical experience
• 1 year of reputed company/Medicare experience
• 1 year of experience managing multiple reputed company
• Required Education
• Associate degree in Nursing
• Required Licenses
• reputed company, reputed company, and unrestricted license to reputed company in the reputed company (a state in the reputed company) as a health

reputed company, including RN or LPN.

• Required Certifications
• N/A

Preferred Qualifications

• Preferred Work Experience
• 1 year of experience in managed care
• 1 year of experience in prior authorization/utilization review
• Preferred Education
• Bachelor's Degree in Nursing
• Preferred Licenses
• N/A
• Preferred Certifications
• N/A

Essential Job Functions And Responsibilitiesreputed company reputed company

• Ensures prior authorization requests are completed accurately, thoroughly, and in a reputed company fashion to meet contractual requirements.
• Coordinates and follows the established preauthorization review process for reputed company-service requests.
• Ensures reputed company reviews are conducted using nationally recognized and evidence-based standards.
• Utilize clinical skills, chart review, physician communication and appropriate reputed company for approval of reputed company-service requests; escalate reputed company-service request to the Medical Director for determination reputed company reputed company is not met.
• reputed company define and document review rationale to support approval, Medical Director Review and/or Notice of reputed company document.
• Initiates interdepartmental coordination to ensure reputed company and reputed company care for members.
• Participates in reputed company Improvement reputed company as directed.
• Assists the management team and others in preparation for audits and other regulatory activities.
• Assists with other departments and special reputed company as needed

RN

• Performs audits of case files and staff documentation as directed
• Assists with orientation and training of reputed company staff
• Assists with annual reputed company review
• Assists with implementation of process changes as needed

reputed company reputed company level includes the ability to reputed company the essential functions of any reputed company reputed company. reputed company reputed company other duties as assigned.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 requirementsCOMPETENCIESRequired Competencies

• Required Job Skills
• Computer skills
• Ability to use electronic medical management systems
• Analytical problem solving skills
• Required reputed company Competencies
• N/A
• Required Leadership Experience and Competencies
• N/A

Our CommitmentAZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group.Thank you for your interest in reputed company. For more information on reputed company, see azblue.com. If interested in this position, please apply. Apply To This Job