Qureos Mentor

Blue Cross Blue Shield of Arizona

AZ Blue, also known as Blue Cross Blue Shield of Arizona, provides a variety of health insurance plans tailored for individuals, families, and businesses. Their offerings include Affordable Care Act (ACA) plans, Medicare Advantage and Supplement plans, and Medicaid services. With a commitment to community health, AZ Blue aims to support its members with accessible healthcare solutions and resources.

<div>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:<ul><li>
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week</li><li>
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week</li><li>
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</li><li>
Onsite: daily onsite requirement based on the essential functions of the job</li><li>
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</li></ul>
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 position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.<div><h2 class="jobSectionHeader">
PURPOSE OF THE JOB
</h2>The Business Intelligence (BI) Developer is responsible for the design, creation, and maintenance of sustainable reporting solutions to support data-driven decisions. Drives significant analytic initiatives in support of business strategies. Develops an understanding of business processes and operational tools in order to create meaningful reporting designs. Responsible for the analysis of business data needs and develops the required data modeling. Designs and develops creative and interactive data visualizations. Partners with business leaders across the organization to support and implement high-quality, data-driven solutions. Assists IT with collecting and storing operational data from source systems. Stays current on all processes, techniques, tools, and industry best practices to ensure BlueCross BlueShield of Arizona is at the forefront of Business Intelligence solutions.
REQUIRED QUALIFICATIONS
Required Work Experience<ul><li>
2 years of Business Intelligence experience</li><li>
3 years of Data Analytics, Dashboarding, Reporting, or Analysis experience</li></ul>
Required Education<ul><li>
High-School Diploma or GED in general field of study</li></ul>
Required Licenses<ul><li>
N/A</li></ul>
Required Certifications<ul><li>
N/A</li></ul>
PREFERRED QUALIFICATIONS
Preferred Work Experience<ul><li>
5 years of Business Intelligence experience</li><li>
5 years of Data Analytics, Dashboarding, Reporting, or Analysis experience</li><li>
2 years Operational experience</li></ul> 

Preferred Education<ul><li>
Bachelor&rsquo;s Degree in Data Science, Business, or related field</li></ul>
Preferred Licenses<ul><li>
N/A</li></ul>
Preferred Certifications<ul><li>
N/A</li></ul>
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES</div><ul><li>
Partner with business leaders and SMEs to understand reporting and analytics needs within their functions.</li><li>
Gather, document, and analyze business reporting requirements.</li><li>
Map business requirements to source data structures and develop data models from data located within multiple data stores utilizing data solutions such as SQL or Snowflake.</li><li>
Design, build, and maintain dashboards visualizations using BI applications such as Tableau or Domo.</li><li>
Ensure dashboards are creatively designed and tell a story behind the data.</li><li>
Analyze report data for accuracy and report on potential quality errors.</li><li>
Participate in peer review process to ensure all reports are accurate prior to distribution.</li><li>
Partner with business owners to prioritize projects to ensure the most important items are being successfully addressed.</li><li>
Partner with IT to identify and store required data sets.</li><li>
Partner with stakeholders to plan, communicate and deliver data visualizations successfully and on time.</li><li>
Provide regular communications on the status of assigned items, both currently being worked and those in the backlog.</li><li>
Provide ongoing analytics expertise and insights into data trends across the operational segments.</li><li>
Lead and facilitate dashboard demonstration and educational sessions</li><li>
Provide ad-hoc data analysis and support to business functions.</li><li>
Perform all other duties as assigned.</li><li>
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.</li></ul>
REQUIRED COMPETENCIES
Required Job Skills<ul><li>
Advanced skills in data applications such as Tableau, SQL, Power BI, ETL</li><li>
Ability to display complex quantitative data in a simple, intuitive format to present findings in a clear manner</li><li>
Creativity in designing data visualizations</li><li>
Strong understanding of data structures that ease the generation of reliable data</li><li>
Strong analytical skills.</li><li>
Proficient Data mining and normalization skills</li><li>
Ability to multitask, prioritize, and manage time efficiently</li><li>
Adaptability / ability to manage change</li><li>
Must be articulate and able to communicate with employees at all levels across the organization, from front-line worker to executives</li><li>
Proficiency in spreadsheet, database and word processing software</li></ul>
Required Professional Competencies<ul><li>
Results focused with successful record of accomplishments</li><li>
Ability to manage multiple priorities</li><li>
Maintain confidentiality and privacy</li><li>
Ability to maintain positive work relationships</li><li>
Ability to complete tasks with limited supervision</li><li>
Ability to think about customer and employee needs when evaluating possible solutions</li></ul>
Required Leadership Experience and Competencies<ul><li>
N/A</li></ul>
PREFERRED COMPETENCIES
Preferred Job Skills<ul><li>
Advanced skills in data applications such as Domo and Snowflake</li><li>
Moderate planning and project management skills</li><li>
Knowledge of statistical concepts and capabilities.</li><li>
Data collection and warehousing knowledge</li><li>
Knowledge of healthcare industry.</li><li>
Advanced PC proficiency</li></ul>
Preferred Professional Competencies<ul><li>
Thorough knowledge of the company&rsquo;s needs, policies and culture</li><li>
Handle multiple and frequently changing priorities</li><li>
Think analytically and problem solve independently</li></ul>
Preferred Leadership Experience and Competencies<ul><li>
N/A</li></ul>
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.</div>

Business Intelligence Developer - Hybrid

<div>
 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:
 
 
 <ul>
 <li>
 Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
 </li>
 <li>
 Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
 </li>
 <li>
 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
 </li>
 <li>
 Onsite: daily onsite requirement based on the essential functions of the job
 </li>
 <li>
 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
 
 
 </li>
 </ul>
 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
 
 
 
 Ensures accuracy and timeliness in the completion of prior authorization (PA) requests to meet contractual requirements and ensures all reviews utilize nationally recognized and evidence-based standards for the Medicaid Segment which includes Medicaid and Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), and Affordable Care Act (ACA) members. Ensures the completion, accuracy, and timeliness in the Notice of Action (NOA) process.
 
 
 
 Qualifications
 
 
 
 
 REQUIRED QUALIFICATIONS
 
 
 
 
 Required Work Experience
 
 
 
 <ul>
 <li>
 3 years of clinical experience
 </li>
 <li>
 1 year of Medicaid/Medicare experience
 </li>
 <li>
 1 year prior authorization and member and provider notification (NOA) experience
 </li>
 <li>
 1 year experience with National Committee for Quality Assurance (NCQA) standards
 
 
 </li>
 </ul>
 
 Required Education
 
 
 
 <ul>
 <li>
 Associate degree in Nursing
 
 
 </li>
 </ul>
 
 Required Licenses
 
 
 
 <ul>
 <li>
 Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN or LPN.
 
 
 </li>
 </ul>
 
 Required Certifications
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 
 Preferred Work Experience
 
 
 
 <ul>
 <li>
 3+ years of experience in managed care
 </li>
 <li>
 3+years of experience in prior authorization/utilization review
 
 
 </li>
 </ul>
 
 Preferred Education
 
 
 
 <ul>
 <li>
 Bachelor of Science in Nursing
 
 
 </li>
 </ul>
 
 Preferred Licenses
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Certifications
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Essential Job Functions And Responsibilities
 
 
 
 
 ALL LEVELS
 
 
 
 <ul>
 <li>
 Ensures the accuracy and timeliness of prior authorization requests to meet contractual requirements.
 </li>
 <li>
 Coordinates and manages the established preauthorization review process for pre-service requests.
 </li>
 <li>
 Ensures the use of nationally recognized and evidence-based standards in the completion of all pre-service reviews.
 </li>
 <li>
 Utilize clinical skills, chart review, physician communication and appropriate criteria for approval of pre-service requests; escalate pre-service request(s) to the medical director for determination when criteria not met.
 </li>
 <li>
 Clearly define and document review rationale to support approval, Medical Director Review and/or Notice of Action document.
 </li>
 <li>
 Initiates interdepartmental coordination to ensure quality and timely care for members.
 </li>
 <li>
 Participates in Quality Improvement Projects as directed.
 </li>
 <li>
 Participate in department audits and other regulatory activities.
 </li>
 <li>
 Engage cross-functionally and participate in special projects as needed.
 </li>
 <li>
 Performs Notice of Action (NOA) process.
 </li>
 <li>
 Participate in annual policy and procedure review and revision.
 </li>
 <li>
 Perform all other duties as assigned.
 </li>
 <li>
 The position requires a full-time work schedule,40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
 
 
 </li>
 </ul>
 
 COMPETENCIES
 
 
 
 
 Required Competencies
 
 
 
 
 Required Job Skills
 
 
 
 <ul>
 <li>
 Computer skills to include Microsoft Office applications, Word, Excel, and Outlook
 </li>
 <li>
 Ability to use electronic medical management systems
 </li>
 <li>
 Analytical problem solving skills
 
 
 </li>
 </ul>
 
 Required Professional Competencies
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Required Leadership Experience And Competencies
 
 
 
 <ul>
 <li>
 N/A
 
 
 </li>
 </ul>
 
 Preferred Competencies
 
 
 
 
 Preferred Job Skills
 
 
 
 N/A
 
 
 
 Preferred Professional Competencies
 
 
 
 N/A
 
 
 
 Preferred Leadership Experience And Competencies
 
 
 
 N/A
 
 
 
 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.
</div>

Prior Authorization Nurse - Remote - AZ

Join Blue Cross Blue Shield of Arizona and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Blue Cross Blue Shield of Arizona

About Company

Business Intelligence Developer - Hybrid

Prior Authorization Nurse - Remote - AZ