Job: CLAIMS MED REVIEW NURSE(Job Id 35931)

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Posted: 02/08/2018

Job Reference #: 35931

Job Description

02/08/2018
HEALTHCARE PROFESSIONALS 22
PHOENIX 64,575.00-64,575.00

 

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

 

 

Claims Med Review Nurse

 

This position will remain open until filled.

 

Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!

 

JOB SUMMARY:

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Medical Review Nurse. After training, this position has the potential to work primarily from home, with some in-office meetings and work being required. This position is responsible for reviewing medical claims and medical documentation submitted by AHCCCS Providers.   Major duties and responsibilities include but are not limited to:

 

* Performs medical claims review/adjudication in a production environment

 

* Prepares reports on review activity

 

* Performs special projects

 

* Reviews and/or defends grievances

 

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

* Hold a current Arizona RN or LPN license

 

* 3 years’ experience in health care delivery systems

 

* Knowledge of acute nursing processes including assessment, planning, intervention and evaluation

 

* Excellent organizational skills resulting in prioritization of multiple tasks

 

* Ability to produce accurate work products with limited supervision

 

* Excellent written and communication skills

 

SELECTIVE PREFERENCE(S):

* Recent experience in concurrent and retrospective review

 

* Experience with CCI, InterQual, HCPCS and CPT Coding

 

* Managed care medical review experience

 

* Certification in CPT Coding is a plus

 

BENEFITS   

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.

           

 

Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.

Click the APPLY NOW button to submit your application.

For technical assistance, email [email protected] or call 602-542-4700.

Application Instructions

Please apply for this position by following the link provided below. A new window will open on your screen and you will be directed to the Arizona Health Care Cost Containment System (AHCCCS) employment website.

Click here to apply with Arizona Health Care Cost Containment System (AHCCCS)

Locations


7101 E Jefferson
Phoenix, AZ 85034
Arizona Health Care Cost Containment System (AHCCCS) - Flagstaff
N/A
Flagstaff, AZ 86001
Arizona Health Care Cost Containment System (AHCCCS)
701 East Jefferson
Phoenix, AZ 85034
Arizona Health Care Cost Containment System (AHCCCS) - Yuma
3850 W. 16th Street, Suite A
Yuma, AZ 85364
Arizona Health Care Cost Containment System - Chinle
Tseyi Shopping Center, Hwy. 191
Chinle, AZ 86503
Arizona Health Care Cost Containment System - Tucson
1010 N. Finance Center Drive, Suite 201
Tucson, AZ 85710
Arizona Health Care Cost Containment System-Globe
2250 Highway 60, Suite H
Miami, AZ 85539
Casa Grande
-
Casa Grande, AZ 85122
Cottonwood
-
Cottonwood, AZ 86326
Kingman Office ALTCS
519 E. Beale Street, Suite 130
Kingman, AZ 86401
Lake Havasu
-
Lake Havasu City, AZ 86403
PRESCOTT VALLEY
-
Prescott Valley, AZ 86312
Sierra Vista
-
Sierra Vista, AZ 85635
Not Specified
-
Not Specified, NS 99997
7101 E Jefferson
Phoenix, AZ 85034
Arizona Health Care Cost Containment System (AHCCCS) - Flagstaff
Arizona Health Care Cost Containment System - Chinle
Arizona Health Care Cost Containment System - Tucson
Arizona Health Care Cost Containment System (AHCCCS)
Arizona Health Care Cost Containment System (AHCCCS) - Yuma
Arizona Health Care Cost Containment System-Globe
Casa Grande
Cottonwood
Kingman Office ALTCS
Lake Havasu
PRESCOTT VALLEY
Sierra Vista
Not Specified

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