- 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
- Cognizant (Phoenix, AZ)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… 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
- 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
- Molina Healthcare (Chandler, 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)
- …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
- 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
- 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
- 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
- Adelante (Phoenix, AZ)
- Family Nurse Practitioner - West Phoenix Job Details Job...the review of protocols and procedures + Review results of utilization and quality monitoring ... ESSENTIAL SKILLS AND EXPERIENCE + Graduate from an approved Nurse Practitioner school + Nurse Practitioner certificate issued by the Arizona Board of Nursing… 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
- 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 ... and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health… 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 ... and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health… more
- Banner Health (Phoenix, AZ)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Highmark Health (Phoenix, AZ)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Phoenix, AZ)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices...UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory… more