- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Phoenix, AZ)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Banner Health (Page, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... ###@bannerhealth.com or ###. **_If you are a New Graduate Nurse with less than 12 months of experience, please...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… more
- LifePoint Health (Bullhead City, AZ)
- …continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and management of discharge ... years management experience, five (5) years of utilization review / case management ...with MedHost EMR and with MorCare Required Licenses[United States] Registered Nurse Current RN Licensure… more
- Molina Healthcare (Tucson, AZ)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
- Veterans Affairs, Veterans Health Administration (Tucson, AZ)
- Summary The Registered Nurse ( RN ) Safety Manager (PSM) ,Supervisor executes position responsibilities that demonstrate leadership, experience, and creative ... approaches to the management program aspects. The PSM Supervisor demonstrates performance and...of care for Quality and Patient Safety. Responsibilities The Registered Nurse ( RN ) Safety Manager… more
- HonorHealth (Scottsdale, AZ)
- …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews...accredited NLN/CCNE institution Required Experience 3 years as a Registered Nurse in an acute care setting… more
- Dignity Health (Phoenix, AZ)
- … Program. + (3-5) Three to five years-clinical RN experience. + Two years Utilization Review Charge Audit Case Management or related experience. + RN ... + Knowledge of hospital billing and charging processes and understanding of Medical Terminology. + Understanding of rules and guidelines to include American Association of Medical Audit Specialists (AAMAS) and National Commission on Insurance Guidelines and… more
- Highmark Health (Phoenix, AZ)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Phoenix, AZ)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Banner Health (Mesa, AZ)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... the community.** Our highly skilled team includes experienced bedside registered nurses, licensed nursing assistants, Neonatologists, NNP, Respiratory Therapist,… more
- Banner Health (Sun City West, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… more
- Highmark Health (Phoenix, AZ)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- CVS Health (Phoenix, AZ)
- …weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Utilization Management is a 24/7 operation.** 100% attendance is required ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...with 100% participation during 8:30am-5pm Monday-Friday EST + A Registered Nurse that must hold an unrestricted… more
- CVS Health (Phoenix, AZ)
- …on weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Utilization Management is a 24/7 operation.** Travel Required up to 5% ... meetings/audits The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible...department + 3+ years inpatient clinical experience as a Registered Nurse + 3+ years of Managed… more
- CVS Health (Phoenix, AZ)
- …+ Understanding or working knowledge of the Arizona Medicaid system + Utilization review experience + Managed Care experience + Experience documenting ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...and Family Therapist (LMFT), LAC, LAMFT, or LMSW **OR** RN with unrestricted Arizona state license or compact … more
- Banner Health (Phoenix, AZ)
- …quality management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission ... position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality of nursing… more
- Molina Healthcare (Mesa, AZ)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… more
- Community Health Systems (Oro Valley, AZ)
- …weekends in Case Management supporting various departments** **What you'll do:** As a Registered Nurse you'll play a vital role in doing what you do best ... administration of the activities of clinical review , discharge planning, resource utilization and utilization review . **Candidates need acute hospital… more
- HonorHealth (Scottsdale, AZ)
- …3 years clinical experience in a hospital setting Required Licenses and Certifications Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal… more