- Centene Corporation (Phoenix, AZ)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- HonorHealth (AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key Responsibilities** + Apply critical thinking… more
- Banner Health (AZ)
- …settings by including remote and hybrid opportunities. As a Health Plan Registered Nurse RN Behavioral Health Quality of Care, you will call upon your behavioral ... meets the qualifications to open as a case to review and determine what next steps should be taken....responsible manner. Performs independently. MINIMUM QUALIFICATIONS Two years of clinical experience in an acute care or outpatient setting;… more
- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- Molina Healthcare (AZ)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- HonorHealth (AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- Healthfirst (AZ)
- …utilization management functions which include timely authorizations related to pre-certification, concurrent review , referrals, and other plan services + ... information required for appropriate utilization management and to solve complex clinical problems + Allocate, monitor, and control resources while delegating and… more