- Humana (Phoenix, AZ)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... Community Care Home and Community Based Services. Care Coordination. Case Management . Process of Home Care consults Grade Determinations: The following… more
- Banner Health (Phoenix, AZ)
- …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
- Evolent (Phoenix, AZ)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… 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 ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… 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)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the ... beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with...completion of a bachelor's degree in case management or health care. Requires current Registered … 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...LVN in the specialty area. Employees working for Banner Home Care AZ must possess an Arizona Fingerprint Clearance… 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 (Phoenix, AZ)
- …helpful. General Experience: navigation or complex care coordination/case management knowledge/experience preferred, clinic/ambulatory experience is helpful, ability ... beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with...of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through… more
- Banner Health (Phoenix, AZ)
- …has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona ... 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
- Molina Healthcare (Chandler, AZ)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Chandler, AZ)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- CVS Health (Phoenix, AZ)
- …active, unrestricted pharmacist licensure within their state of residence.** Medication Therapy Management supports the company vision to help people on their path ... The role of the MTM Pharmacist is to deliver telephonic medication therapy management (MTM). Effective delivery of this CVS Health telephonic based MTM service… more
- Sharecare (Phoenix, AZ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- ZOLL Medical Corporation (Phoenix, AZ)
- …medical device technology company that focuses on the development and manufacturing of Home Sleep Apnea Tests to aid in the diagnosis of respiratory sleep disorders. ... Our core product is the WatchPAT(R)️ family, a revolutionary FDA-cleared portable home sleep apnea test device, that is based on proprietary signal and analysis. 80%… more
- Molina Healthcare (Chandler, AZ)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… more