- ERP International (Luke AFB, AZ)
- …and 5:00pm, including a one hour lunch **Core Duties:** - Participate in Utilization Management/Case Management meetings to review and identify opportunities to ... work CM services. - Provide patient referrals. - Interface with the MTF RN Case Manager(s) in the development and implementation of the Case Management Program… more
- Parexel (Phoenix, AZ)
- …reproducible research practices like version control and literate programming. + BSN, RN , RPh, Pharm D, PA, MPH, or other applicable health professional credentials, ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- 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
- Humana (Phoenix, AZ)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Molina Healthcare (Phoenix, AZ)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (Phoenix, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Phoenix, AZ)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… 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
- 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 ... lives, we want to hear from you. As the RN Case Manager in Care Coordination, you will have...pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of… more
- Banner Health (Phoenix, 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 ... lives, we want to hear from you. As the RN Case Manager in Care Coordination, you will have...pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of… more
- Cognizant (Phoenix, AZ)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...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 ... partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. +… more
- Molina Healthcare (Phoenix, 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...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Humana (Phoenix, AZ)
- …concerns.** **Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse ( RN ) Multi-state/Compact State license with no ... caring community and help us put health first** The Nurse Advice Line is a fast-paced inbound call center...Bachelor's degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous… 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...clinical nursing services, and assumes leadership of nursing personnel ( RN , MA) at designated site(s). They will clinically supervise… more
- Molina Healthcare (Phoenix, 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Phoenix, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** *… more
- Molina Healthcare (Phoenix, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** *… more
- Molina Healthcare (Phoenix, AZ)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- CenterWell (Phoenix, AZ)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing 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 focuses on excellent… more
