- Centene Corporation (Phoenix, AZ)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
- Adelante (Phoenix, AZ)
- …with the clinical team on data collection, health outcomes reporting, clinical audits, and programmatic evaluation. + Review and take action on ... Registered Nurse - West Phoenix Job Details Job Location...nursing; license in good standing + Demonstrated understanding of clinical methods and techniques used in record-keeping systems +… more
- Molina Healthcare (Phoenix, AZ)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …Health Care System is currently recruiting for a full time Licensed Practical Nurse (Community Living Center) within the Geriatric and Extended Care Service, located ... Standard Operating Procedures (SOPs) for all RME in the clinical area. She/he is responsible for carrying out proper...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- Evolent (Phoenix, AZ)
- …Participates in the development and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology ... will be the single point of responsibility for all clinical operations inclusive of nurse , physician, and...highly desirable. + High level of financial acumen, with prior P&L responsibility preferred. + Proficiency creating and leading… more
- Select Medical (Phoenix, AZ)
- …highly effective level of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse (RN) or Respiratory ... License. + Will consider other designations like LPN, PT, OT etc., upon further review . + Ability to complete clinical assessments of medically complex patients.… more
- CVS Health (Phoenix, AZ)
- …enhance a member's overall wellness through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's ... What is A1A? Aetna One Advocate is Aetna's premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers… more
- Indian Health Service (Phoenix, AZ)
- …Indian Medical Center (PIMC), within Ambulatory Services. As a Licensed Clinical Social Worker, the incumbent ensures patients receive quality patient centered ... appropriate, cost effective, sensitive and coordinated to achieve desired clinical outcomes. Responsibilities **This position is being re-advertised to solicit… more
- Evolent (Phoenix, AZ)
- …request. + Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. + Addressing ... our daily operations this individual also works with our clinical team, which includes our Nurse , ...and policies to determine if submitted requests require a prior authorization review or redirect as required.… more
- Baylor Scott & White Health (Phoenix, AZ)
- **JOB SUMMARY** Clinical Doc Improvement Specialist 1 performs patient record reviews concurrently and/or retrospectively to determine complete, accurate and timely ... to physicians when needed to clarify ambiguous or incomplete documentation. The Clinical Doc Improv Spec 1 should have knowledge of ICD-10, Complications/Comorbid… more
- Indian Health Service (Phoenix, AZ)
- …concurrently under Delegated Examining Plan (DE) procedures. Please review vacancy announcement number IHS-24-PX-12391701-DE; for eligibility requirements. NOTE: ... The selected individual is required to obtain and maintain medical staff clinical privileges, including any licensure requirements. If privileges are not obtained or… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... university. Major duties include but not limited to the following: Clinical , teaching and administrative responsibilities under the guidance and direction of… more
- Dignity Health (Phoenix, AZ)
- …nursing staff in the infusion suite, offering patient education, and participating in clinical decision making. They review and create care guidelines, and ... solve through critical thinking. Staff pharmacists work collaboratively with physicians, nurse practitioners, nurses and other members of the care team. Cancer… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... of the cardiology section including cardiology physicians, physician assistants, nurse practitioners, nurses, diagnostic radiology technicians, medical instrument technicians,… more
- Indian Health Service (Phoenix, AZ)
- …recruitment action tracking activities including sending a weekly update/summary to clinical directors on all pending actions and reminders for pending signatures. ... investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. After you begin your employment, your continued… more