- 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
- Molina Healthcare (Mesa, AZ)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
- Banner Health (Scottsdale, 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
- Molina Healthcare (Mesa, AZ)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Mesa, 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 of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Mesa, AZ)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- Molina Healthcare (Mesa, AZ)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Town of Gilbert (Gilbert, AZ)
- …- 2 years + 3 - 4 years + 5+ years 04 Are you a certified paramedic, registered nurse or licensed practical nurse ? + Yes + No 05 How many years of experience do ... 06 Describe your experience related to quality assurance (QA) review related to patient care reports and ambulance billing....NA. 14 Please describe your work experience involving ambulance utilization and deployment. if you do not have experience… more