- Healthfirst (AZ)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **This position is 100% Remote **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Highmark Health (Phoenix, AZ)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- ERP International (Luke AFB, AZ)
- …license to practice as a Registered Nurse, any state. Clinical Certification:** Certified Case Manager by Commission for Case Management (CCM) **or** ... databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with social work case management. *… more
- Dignity Health (Mesa, AZ)
- …state RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Training: + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...with multiple stakeholders + Understand how utilization management and case management programs integrate. + Ability to work as… more
- Dignity Health (Phoenix, AZ)
- …state RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Training: + Knowledge of managed ... acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1...with multiple stakeholders + Understand how utilization management and case management programs integrate. + Ability to work as… more
- CommonSpirit Health (Phoenix, AZ)
- …of nursing experience. * Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred **Overview** Hello ... * Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. * AZ RN license… more
- Healthfirst (AZ)
- …with demonstrated ability to handling rapidly changing crisis situations + Knowledge of UM /QM case philosophies and reporting requirements to state and federal ... agencies + Ability to allocate, monitor, and control resources while delegating and monitoring workloads + Ability to effectively manage performance as well as set and achieve goals **Compliance & Regulatory Responsibilities:** + Ensures Care Management team… more
- Molina Healthcare (Chandler, AZ)
- …Certified Clinical Coder + Certified Medical Audit Specialists (CMAS) + Certified Case Manager (CCM) + Certified Professional Healthcare Management (CPHM) ... The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as… more
- Sharecare (Phoenix, AZ)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance + Primary duties include but are not limited to: +… more