- Parexel (Phoenix, AZ)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- Dignity Health (Mesa, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted… more
- Centene Corporation (Phoenix, AZ)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and be licensed in Arizona **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and… more
- Humana (Phoenix, AZ)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (Scottsdale, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Scottsdale, AZ)
- … and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical...a hospital setting, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (Scottsdale, AZ)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
- Molina Healthcare (Scottsdale, AZ)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Banner Health (Mesa, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of… more
- Banner Health (Phoenix, AZ)
- …the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in ... lives, we want to hear from you. As the RN Case Manager in Care Coordination, you will have...pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of… more
- CVS Health (Phoenix, AZ)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Cognizant (Phoenix, AZ)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- … of the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Registered Nurse ( RN ) is responsible and accountable for all ... and initiatives as well as customer service programs. The Inpatient Mental Health (MH) Registered Nurse ( RN ) provides and leads the provision of competent,… more
- Evolent (Phoenix, AZ)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… more
- Highmark Health (Phoenix, AZ)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Banner Health (Phoenix, AZ)
- …This position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality ... 2. Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing...Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the… more
- Banner Health (Phoenix, AZ)
- …This position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality ... 2. Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing...Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the… more
- Highmark Health (Phoenix, AZ)
- …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year ... **Required** + None **Preferred** + PA clinical licensure/certifications such as RN , RD, Pharmacist **Language (Other than English):** None **Travel Requirement:**… more
- Molina Healthcare (Scottsdale, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- CVS Health (Phoenix, AZ)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, ... ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the… more
