- 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 (Chandler, AZ)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who be licensed in the state they reside. We are looking for a RN Supervisor ... and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management… more
- Molina Healthcare (Chandler, 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 (Chandler, AZ)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… 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
- 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
- Select Medical (Mesa, AZ)
- …Interventions/Discharge and Care Planning Management, Fiscal Management and Payer/Referral Management, Utilization Review . The Director of Case Management is ... vision, and dental plan offerings + **Invest in Your Future:** 100% paid RN scholarship program, company-matching 401(k) retirement plan, as well as life and… 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
- 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
- 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)
- …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 (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