- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring… more
- CVS Health (Phoenix, AZ)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CenterWell (Phoenix, AZ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- Summary The Registered Nurse , Quality Management Consultant position is located within the Quality and Patient Safety Service at the Phoenix VA Healthcare System ... | VA Phoenix Health Care | Veterans Affairs Responsibilities The Quality Management (QM) Consultant Registered Nurse (RN) demonstrates leadership, experience,… more
- Banner Health (Phoenix, AZ)
- …, acute care and/or home care environments, community resources and resource/ utilization management . Must demonstrate critical thinking skills, problem-solving ... networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …AZ. It is a Level 1a major interdisciplinary teaching facility. The Chief Nurse , Sterile Processing Service is the administrative and accountable official for the ... within the organization. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards Duties Include but not limited to: The CN SPS… more
- Molina Healthcare (Phoenix, AZ)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Mayo Clinic (Phoenix, AZ)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, and… more
- Molina Healthcare (Phoenix, AZ)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Corning Incorporated (Glendale, AZ)
- …and time management skills. + Great computer skills and EMR utilization **Desired Qualifications:** + Certified Occupational Health Nurse (COHN | COHN-S) ... Occupational Health Nurse **Date:** Dec 11, 2025 **Location:** Glendale, AZ,...processing of work-related illnesses or injuries. Ensure effective case management . + Absence management - utilize Corning's… 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 ... pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Intermountain Health (Phoenix, AZ)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Evolent (Phoenix, AZ)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Banner Health (Phoenix, AZ)
- …will serve as primary patient and caregiver contact for education, symptom management , and care plan adherence, coordinate care across inpatient, outpatient, and ... oversee ambulatory detox monitoring, specialty medication administration (Vivitrol), lab management , and medication reconciliation, support efforts to reduce readmissions… 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
- Banner Health (Phoenix, AZ)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... and clinical support to patients and staff. Uses depth and breadth of clinical management knowledge to ensure the provision of high quality, safe, and cost effective… more
- Banner Health (Phoenix, AZ)
- …helpful. General Experience: navigation or complex care coordination/case management knowledge/experience preferred, clinic/ambulatory experience is helpful, ability ... the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating… more
- Banner Health (Phoenix, AZ)
- …the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating ... communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 9. This position works independently, with… more
- Select Medical (Phoenix, AZ)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more