- Molina Healthcare (Phoenix, AZ)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... For this position we are seeking a (RN) Registered Nurse who be licensed in the state they reside....are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office… more
- HonorHealth (Scottsdale, AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Molina Healthcare (Phoenix, AZ)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... **Required Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical … more
- Evolent (Phoenix, AZ)
- …Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Phoenix, AZ)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Banner Health (Phoenix, AZ)
- …the best cost-quality and outcomes possible. To be successful in this role **a nurse with** **Work experience on Med surg, ICU or WIS** **experience is highly ... use variation and costs through the development of consensus supply utilization programs and initiatives. Responsible for clinical and related operational financial… more
- Adelante (Phoenix, AZ)
- …audits, continuing education, and the review of protocols and procedures + Review results of utilization and quality monitoring and participate in the ... Adult Nurse Practitioner Job Details Job Location Adelante Healthcare...- Phoenix, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job Category Health Care Description POSITION SUMMARY… more
- CVS Health (Phoenix, AZ)
- …with transferring patients to lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation preferred - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Phoenix, AZ)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Molina Healthcare (Phoenix, AZ)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- Molina Healthcare (Phoenix, AZ)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Adelante (Mesa, AZ)
- Registered Nurse - Mesa, AZ Job Details Job Location Adelante Healthcare Mesa - Mesa, AZ Position Type Full Time Job Category Health Care Description POSITION ... SUMMARY This Registered Nurse functions to assist all patients and their families...health outcomes reporting, clinical audits, and programmatic evaluation. + Review and take action on care team tasks and… more
- Adelante (Mesa, AZ)
- Adult Nurse Practitioner - Mesa Job Details Job Location...the review of protocols and procedures + Review results of utilization and quality monitoring ... Adelante Healthcare Mesa - Mesa, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job Category Health Care Description POSITION SUMMARY The Adult … more
- Banner Health (Phoenix, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... the happiness, satisfaction, wellbeing and fulfilment of their employees. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity to… more
- Sharecare (Phoenix, AZ)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- CVS Health (Phoenix, AZ)
- …unrestricted state licensure required in state of residence **Preferred Qualifications** Utilization Management review Managed Care experience Client processing ... each and every day. **Position Summary** Responsible for the review and evaluation of clinical information and documentation. Reviews...experience **Education** Registered Nurse **Anticipated Weekly Hours** 40 **Time Type** Full time… more
- Lincoln Financial (Phoenix, AZ)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent (Phoenix, AZ)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Banner Health (Mesa, AZ)
- …service skills, and flexibility. Congruence of perceptions in the nurse -patient relationship and therapeutic communications are essential characteristics. Your pay ... and advanced technology that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of the top 50 busiest… more