- Dignity Health (Chandler, 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 based on… more
- Dignity Health (Gilbert, 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 based on… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or...year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and… more
- CenterWell (Phoenix, AZ)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe 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
- Centene Corporation (Phoenix, AZ)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Humana (Phoenix, AZ)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Center, Nursing Service, Phoenix VA Healthcare System in Phoenix, AZ The Registered Nurse Community Living Center (CLC) Minimum Data Set (MDS) Registered Nurse … more
- Veterans Affairs, Veterans Health Administration (Tucson, AZ)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements,… more
- Veterans Affairs, Veterans Health Administration (Tucson, AZ)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates MH knowledge, skills, abilities, ... ###@va.gov for questions/assistance. Responsibilities The Inpatient Mental Health (MH) Registered Nurse (RN) executes their position duties to improve patient and… more
- Molina Healthcare (Scottsdale, AZ)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… more
- Adelante (Phoenix, AZ)
- Registered Nurse Supervisor Job Details Job Location Adelante Healthcare Center Support Office - Phoenix, AZ Position Type Full Time Education Level RN Job Category ... Health Care Description POSITION SUMMARY The Registered Nurse Supervisor is responsible for the overall leadership of...health outcomes reporting, clinical audits, and programmatic evaluation. + Review and take action on care team tasks and… more
- Adelante (Surprise, 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...- Surprise, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job Category Health Care Description POSITION SUMMARY… 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 ... Womens Health Nurse Practitioner - West Phoenix Job Details Job...- Phoenix, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job Category Health Care Description POSITION SUMMARY… 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 ... of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through...in case management or health care. Requires current Registered Nurse (RN) license in state worked. For assignments in… 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
- Sharecare (Phoenix, AZ)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Adelante (Goodyear, AZ)
- …audits, continuing education, and the review of protocols and procedures + Review results of utilization and quality monitoring and participate in the ... Family Nurse Practitioner - Goodyear Job Details Job Location...ESSENTIAL SKILLS AND EXPERIENCE + Graduate from an approved Nurse Practitioner school + Nurse Practitioner certificate… more
- HonorHealth (AZ)
- …in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal ... of the health care team in determining the appropriate level of care, utilization of resources and length of stay (utilizing electronic admission and discharge… more
- Banner Health (Tucson, AZ)
- …provider networks, and regulatory agencies. Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... environments, and resources that promote a healthy work-life balance. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity to… more