Job Description

09/16/2020 09/30/2020
PHOENIX 64,575.00-0.00

Arizona Health Care Cost Containment System

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


First Resume Review: 09/30/2020

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.

All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!


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 a successful training period, 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

* Evaluates medical documentation for emergency criteria, medical necessity and correct CPT


* Prepares reports on review activity

* Performs special projects

* Reviews and/or defends appeals


* Hold a current Arizona RN or LPN license

* Minimum 3 years acute care experience.

* 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

* Intermediate computer skills


* 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


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 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.

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