- Molina Healthcare (Scottsdale, AZ)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and ... knowledge of Interqual / MCG guidelines. COMPACT / Multi state RN LICENSURE IS PREFERABLE to support multiple states._** **_Excellent computer skills and attention to detail are very important to multi task between systems, talk with members on the phone, and… more
- Highmark Health (Phoenix, AZ)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Banner Health (AZ)
- …projects, lead meetings that involve clinical quality/performance improvement. Overseeing the review of quality of care concerns with either transfers or medication ... Officer or Chief Nursing Officer. Experience with leverage data to review current performance, identify opportunities for improvement, and creating action plans… more
- Prime Therapeutics (Phoenix, AZ)
- …into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. + Demonstrates flexibility in areas such as job duties ... responds to Crisis calls and continues assistance with the Clinician until the call has been resolved. + Informs...may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our… more