- CVS Health (Phoenix, AZ)
- …Arizona time zone. No weekends, holidays are required. **Preferred Qualifications** : + Utilization management experience + Clinical experience in Emergency ... more
- Humana (Phoenix, AZ)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the ... more
- Humana (Phoenix, AZ)
- …of objectives and determines approach, resources, schedules and goals. The Manager, Utilization Management Behavioral Health uses clinical knowledge, ... more
- Molina Healthcare (Phoenix, AZ)
- …Hearing Officer during Fair Hearings as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and ... more
- Centene Corporation (Phoenix, AZ)
- …Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. NICU concurrent review nurse preferred ... more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …in the CLC. Documenting and taking corrective action when notified by the CLC management team, charge nurse , or designee of any discrepancies in coding or ... more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …shared vision and advance goals. Provides guidance and oversight of program management to ensure proper resource utilization . Participates in continuous learning ... more
- Adelante (Phoenix, AZ)
- Adult Nurse Practitioner Job Details Job Location Adelante Healthcare West Phoenix - Phoenix, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job ... more
- Banner Health (Phoenix, AZ)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the ... more
- Molina Healthcare (Phoenix, AZ)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM ... more
- Banner Health (Phoenix, AZ)
- … clinical specialty area. Must have a working knowledge of care management , resource/ utilization management , and hospital and community resources. Must ... more
- Molina Healthcare (Phoenix, AZ)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... more
- Evolent (Phoenix, AZ)
- …performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization ... more
- Molina Healthcare (Phoenix, AZ)
- …integrated) performing one or more of the following activities: utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.). ... more
- Banner Health (Phoenix, AZ)
- …position provides administrative supervision of campus workflow, resource utilization and management , and operations for all clinical and non- clinical ... more
- Molina Healthcare (Phoenix, AZ)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, ... more
- Banner Health (Phoenix, AZ)
- …ED, Dialysis, Oncology or Telemetry. Must have a working knowledge of care management , resource/ utilization management , and hospital and community resources. ... more
- CenterWell (Phoenix, AZ)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... more
- Molina Healthcare (Phoenix, AZ)
- …or LMHC) * Minimum of 6 years' experience in health care * Understanding of clinical operations: utilization management , case management , etc. * Ability ... more
- Evolent (Phoenix, AZ)
- …documented, and communicated clearly **What You Will Be Doing:** The Clinical Letter Writer is responsible for reviewing adverse determination decisions against ... more