- Molina Healthcare (Scottsdale, AZ)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… more
- Molina Healthcare (Scottsdale, AZ)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Scottsdale, AZ)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Tucson, AZ)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (AZ)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional… more
- Molina Healthcare (Tucson, AZ)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- HonorHealth (AZ)
- …institution RequiredExperience3 years Registered Nurse in an acute care setting. Required1 year experience in UR/ UM or Case Management RequiredLicenses ... -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health … more
- Molina Healthcare (AZ)
- …to other clinical programs. * Collaborates with multidisciplinary teams to promote Molina care model. * Adheres to utilization management ( UM ) policies and ... experience with MCG guidelines. At least 2 years of experience with inpatient concurrent review , prior authorization and managed care ; Acute care hospital… more
- Dignity Health (Chandler, AZ)
- …Coordinators and other stakeholders regarding review outcomes. + Collaborates with facility RN Care Coordinators to ensure progression of care . + Engages ... of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of… more
- Dignity Health (Gilbert, AZ)
- …Coordinators and other stakeholders regarding review outcomes. + Collaborates with facility RN Care Coordinators to ensure progression of care . + Engages ... of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of… more
- Datavant (Phoenix, AZ)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...bring to the table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred +… more
- Highmark Health (Phoenix, AZ)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... across various UM specialty teams as needed, ensuring continuity of care and operational support. + Participate in occasional on-call rotations, including some… more
- Evolent (Phoenix, AZ)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support… more