Full-Time

Initial Clinical Reviewer-RN

AZ

Posted on 10/31/2025

Blue Cross Blue Shield of Arizona

Blue Cross Blue Shield of Arizona

1,001-5,000 employees

Health insurance products and services

No salary listed

Phoenix, AZ, USA

Remote

Remote in-state AZ only; residency within Arizona required.

Category
Medical, Clinical & Veterinary (2)
,
Requirements
  • 2 years of experience in clinical field of practice, health insurance, or other health care related field
  • Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN, LPN, LPT, LPC, LBSW, LMSW, or LCSW.
Responsibilities
  • Assist with transplant admissions, pre-transplant authorizations, care management/coordination, and regulatory reporting
  • 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.
  • 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 and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • The position has an expectation of 5 days per week and 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.
Desired Qualifications
  • 3 years of experience in clinical field of practice, health insurance, or other health care related field
  • Bachelor's Degree in Nursing or related field of study
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
Blue Cross Blue Shield of Arizona

Blue Cross Blue Shield of Arizona

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Blue Cross Blue Shield of Arizona provides health insurance products and services to more than 1 million Arizonans, offering plans for individuals, families, and businesses as well as Medicare supplement plans for seniors. It operates as an independent not-for-profit licensee of the Blue Cross Blue Shield Association with a network-based model: members receive care by choosing providers within a negotiated network, while the insurer handles underwriting, benefits administration, claims processing, and care services. The company differentiates itself through its local Arizona footprint, community involvement, and not-for-profit status, plus a broad local presence across Phoenix and other cities. Its goal is to improve the quality of life for Arizonans by delivering affordable health coverage and tools to help people make better health decisions, supported by community volunteering and charitable contributions.

Company Size

1,001-5,000

Company Stage

N/A

Total Funding

N/A

Headquarters

Phoenix, Arizona

Founded

1939

Simplify Jobs

Simplify's Take

What believers are saying

  • $200,000 scholarships train healthcare workers at Maricopa Colleges.
  • Community health fairs with CFA pilot student workforce programs.
  • Primary care expansion via VitellaCare and Crossover Health partnership.

What critics are saying

  • National competitors UnitedHealth and Humana displace in 18-24 months.
  • $2.8B antitrust settlement imposes pricing restrictions in 6-12 months.
  • Curant Health underperformance regresses Star Ratings in 12-18 months.

What makes Blue Cross Blue Shield of Arizona unique

  • AZ Blue earned Arizona's only 4.5-Star non-SNP Medicare Advantage rating for 2026.
  • Partnership with Curant Health achieved first 4-Star overall rating in 2024.
  • Non-profit licensee serves 1 million Arizonans since 1939.

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Benefits

Health Insurance

Hybrid Work Options

Remote Work Options

Flexible Work Hours

Company News

West Valley View
Apr 9th, 2026
AFHSD expands hands-on learning with health fair.

AFHSD expands hands-on learning with health fair. * By Joshua Fenty, West Valley View Staff Writer * Apr 9, 2026 Updated Apr 9, 2026 The Agua Fria High School District is on a mission to expand work-based learning opportunities for its students, including experiences that promote various health care careers. With that goal in mind, Canyon View High School will host a community health fair, realized through the district's collaboration with the Center for the Future of Arizona (CFA) and Blue Cross Blue Shield of Arizona (AZ Blue). "Anytime a student can get any sort of hands-on work experience is so valuable in their education - both from an exploratory standpoint and from an experiential standpoint," CFA Project Manager Erin McGehean said. "Those students get to practice different employability skills, like working with the public and developing soft skills, while also learning more about the different careers available to them." The work-based learning program, she explained, will serve as a pilot program to help build and refine a framework to be replicated in other schools across the state. Blue Cross Blue Shield of Arizona has hosted similar community health fairs across the state, but this marks the first time students will participate in structured, work-based learning roles. The Community Health Fair will unfold on Canyon View High School campus on Thursday, April 23, from 4 to 7 p.m. Various health care professionals will be at the fair, working with and mentoring Canyon View High School students, to offer free medical services, resources and information. Attendees will have access to free health screenings and biometrics, dental screenings and opportunities to get connected to other services that may benefit them and special goodie bags. According to the project manager, the CFA and AZ Blue considered ways in which all Career and Technical Education students might have opportunities to contribute to the fair. One of the ideas that was discussed, she said, was the possibility of having the culinary students prepare and cater meals for their peers in medicine and the health care professionals working the event. Participation among the students will vary based on grade level, McGehean said. Freshman students in attendance will explore the fair, speaking with various professionals to learn more about career opportunities in the medical field. The upperclassmen who are engaged in CTE pathways will be the students assisting with health screenings and gaining experience. Additionally, the organization will gather student feedback to sharpen the program's framework for the future. For McGehean, schools can experience difficulty in connecting their students to internship opportunities and individual scheduling conflicts add to the challenge as well. This program helps to bridge that gap, she said. "This is a win-win for the employers, the communities, the schools and the students, to be able to work together to provide students with these experiences," the project manager said. "Especially in some of our rural communities across the state, they have trouble getting connected into industry experiences - this will provide that opportunity." The Center for the Future of Arizona's mission, as stated on its website, is to bring "Arizonans together to create a stronger and brighter future for (the) state." For McGehean, helping to develop the doctors, nurses and medical professionals of tomorrow helps to secure that brighter future. As the event date rapidly approaches, the project manager said she is thrilled to see the students step into their roles and help people - adding that their professionalism and aptitude will surprise the crowds. "I think there's a lot of misconceptions about how high school students are, and I think they're going to challenge a lot of those assumptions," McGehean said. "I think the community is going to see how engaged and willing they are to provide service and work with people - they'll bring hope to the community."

PR Newswire
Apr 1st, 2025
$200,000 Gift Expands Healthcare Education And Workforce In Maricopa County

AZ Blue Invests in Scholarships to Train Arizona's Future Healthcare Workers PHOENIX, April 1, 2025 /PRNewswire/ -- Arizona needs more workers in healthcare. Across the state, there is a shortage of health providers making it hard for patients to get the care they need. To help bridge the gap, AZ Blue is giving $200,000 in aid to future health workers. The gift, from AZ Blue Health Choice and the AZ Blue Foundation, provides need-based support for hundreds of students at Maricopa Community Colleges. "Investing in students will go on to strengthen Arizona's health system," said Heather Carter, Medicaid Segment General Manager and Health Choice of Arizona CEO. "It's a chance for students to start careers that will make an impact in the lives of Arizonans."

PR Newswire
Feb 5th, 2025
Over $17 Million In Medical Debt Wiped Out For Arizonans

Thousands benefit from AZ Blue Foundation's work with Undue Medical Debt. PHOENIX, Feb. 5, 2025 /PRNewswire/ -- Every month across Arizona, thousands of people face a tough choice: Pay their medical bills or use that money to buy groceries or other essentials needed to get by. Now, more than 12,000 people have less to worry about – thanks to the AZ Blue Foundation

KFYR-TV
Dec 13th, 2024
VitellaCare opens primary care office on Trinity Health Medical Campus

Insurers Healthy Dakota and BCBS partnered with Crossover Health, an advanced primary care company.

Bilkuj
Dec 6th, 2024
Blue Cross Reaches Preliminary Approval For $2.8 Billion Antitrust Settlement

The lawsuit, originally filed in 2012, accused Blue Cross and its affiliates of violating antitrust laws by dividing the U.S. into exclusive regional areas, thereby preventing competition among themselves.

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