- Dignity Health (Phoenix, 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
- Molina Healthcare (Phoenix, 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
- Molina Healthcare (Phoenix, AZ)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (Phoenix, AZ)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- CVS Health (Phoenix, AZ)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) 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
- CenterWell (Phoenix, AZ)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Banner Health (Sun City, 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 ... and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health… more
- Dignity Health (Phoenix, AZ)
- …high levels of patient satisfaction. The Care Coordinator consistently conducts the utilization review process and the discharge planning process as required ... (5) years of nursing experience. **Licensure:** Active Arizona or Compact state RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM-… more
- CVS Health (Phoenix, AZ)
- …Assessment of members through the use of clinical tools and information/data review , conducts comprehensive evaluation of member's needs and benefit plan eligibility ... while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external… more
- Sedgwick (Phoenix, AZ)
- …to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines; and to ... provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the provision of these… more
- Highmark Health (Phoenix, AZ)
- …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Highmark Health (Phoenix, AZ)
- …Health **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
- Banner Health (Glendale, 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
- CVS Health (Phoenix, AZ)
- …+ Licensed Professional Counselor (LPC) + Licensed Marriage and Family Therapist (LMFT) + Registered Nurse ( RN ) + Associate-level licenses may be considered ... of children and adolescents? Join Mercy Care as a Behavioral Health Utilization Management Clinician and become part of a mission-driven team that's transforming… more
- Banner Health (Scottsdale, AZ)
- …current RN License may take Doctor's orders. 4. Conducts initial utilization review by obtaining treatment authorizations as appropriate with representatives ... of managed care or other necessary agencies/individuals. Documents accurately and coordinates with patient financial services and payers regarding treatment authorized. 5. Identifies the full spectrum of mental health disorders as listed in the Diagnostic and… more
- Molina Healthcare (Phoenix, AZ)
- …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- Adelante (Phoenix, AZ)
- … Practitioner certificate issued by the Arizona Board of Nursing + Valid Arizona Registered Nurse license + Valid Arizona Advanced Practice license + Valid DEA ... Family Nurse Practitioner Float - West Phoenix Job Details...the review of protocols and procedures + Review results of utilization and quality monitoring… more
- Adelante (Phoenix, AZ)
- … Practitioner certificate issued by the Arizona Board of Nursing + Valid Arizona Registered Nurse license + Valid Arizona Advanced Practice license + Valid DEA ... Family Nurse Practitioner - West Phoenix Job Details Job...the review of protocols and procedures + Review results of utilization and quality monitoring… more