- CVS Health (Phoenix, AZ)
- …And we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… more
- Humana (Phoenix, AZ)
- …help us put health first** Full-Time, Remote Telephonic opportunity 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
- Humana (Phoenix, AZ)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Phoenix, AZ)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... 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 to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Dignity Health (Gilbert, AZ)
- …and Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is...clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Evolent (Phoenix, AZ)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Evolent (Phoenix, AZ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Molina Healthcare (Chandler, AZ)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …CC Coordinator possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Veterans Affairs, Veterans Health Administration (Scottsdale, AZ)
- Summary The Clinical Registered Nurse position is located within Ambulatory Care service at the Northeast Phoenix VA Clinic, Scottsdale, AZ. Responsibilities The ... promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of… 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
- Banner Health (Gilbert, AZ)
- …position provides administrative supervision of campus workflow, resource utilization and management , and operations for all clinical and non- clinical ... receive care. Clinical Care Operations is the hub of patient management for the campus, including: bed assignment, unit staffing (scheduling, balancing, casual… 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 ... **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care This position is eligible for a $10,000...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Mayo Clinic (Phoenix, AZ)
- …by ensuring appropriate utilization management , care coordination, resource utilization , and clinical documentation. The RN Case Manager will function ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, and… more
- Banner Health (Gilbert, AZ)
- …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 ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
- Banner Health (Phoenix, AZ)
- …Phoenix, Arizona **Department Name:** Banner Staffing Services-AZ **Work Shift:** Day **Job Category:** Clinical Care Good health care is key to a good life. At ... mid-shifts or nights and no on call requirement. The Nurse Navigator works collaboratively to remove barriers for their...or experience in: navigation, complex care coordination, or case management and the ability and willingness to learn new… more
- Banner Health (Phoenix, AZ)
- …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 ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
- Molina Healthcare (Chandler, 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