Hire the right healthcare staff with speed and precision locally or nationwide.

Learn More

How to Cost-Effectively Build a Nursing Staff in an Age of Travel Nursing

Uncover alternative and sustainable staffing solutions to address nursing shortages

Read the article

Life Sciences

Hire skilled life sciences talent by partnering with a nationwide recruitment agency with local market expertise.

Current Trends in the Life Sciences Job Market

Learn how partnering with a staffing agency is a powerful way to combat the challenges of hiring in the current life sciences job market

Read the article


Execute critical healthcare IT initiatives with increased flexibility and cost-effectiveness with us at your side.

The Technology Hiring Outlook: What We're Seeing Right Now

Uncover how to handle an employee-led technology market.

read the article

For JobSeekers

Match your unique skills with in-demand jobs at growing organizations.

Learn More

Resource Center

Explore our library of insights and tips designed to help healthcare leaders and job candidates align.

Explore resources

About Us

We’re positively impacting lives as a leading provider of workforce solutions for clients and talent.

Learn More

Back to jobs

Remote Registered Nurse

Posted: July 02, 2024
Salary:US$40 - US$42 per hour
Job type: Contract
Discipline:Care Management
Work Location:Remote

Job description

We are seeking skilled Medicaid Claims Reviewers with a solid clinical Behavioral Health background to join our remote team. We are assisting AZ AHCCCS in identifying and addressing fraudulent claims related to Behavioral Health services.

Project Alignment
* Specifically aligned with AZ Medicaid-AHCCCS
* Addressing issues identified last year regarding incorrect billing and servicing of Behavioral Health services for AHCCCS patients

Key Responsibilities
* Review AHCCCS claims, both prepayment and post-service, to identify potential fraud
* Verify if the services were actually provided
* Ensure services were done, billed, or coded correctly
* Utilize AHCCCS-specific programs and Microsoft Office apps (e.g., Excel)

* High frequency of Mental Health, Substance Abuse, and Detox services among AHCCCS patients
* Phoenix, the 5th most populated US city, has a significant tribal community presence with at least five surrounding the city

* Review approximately 12-18 claims per day (varies daily)

* Collaborate with a Director and Associate Project Director (both experienced nurses)
* Work alongside many other nurses from across the US on this project

* AZ RN License or compact state license (preference for those in AZ) OR active AZ LCSW or LMSW license
* Master's degree for licensed behavioral health professionals
* Minimum 2 years of clinical Behavioral Health experience
* Minimum 2 years of chart review experience (UM, clinical review, quality review, etc.)

Nice to Have
* Remote work experience

Soft Skills
* General understanding of the changing healthcare environment
* Strong analytical and attention to detail skills
* Excellent communication and teamwork abilities

* Monday to Friday, 8:00AM - 5:00PM

* $40 to $42 an hour