- Banner Health (Phoenix, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Molina Healthcare (Phoenix, AZ)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference… more
- Highmark Health (Phoenix, AZ)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Phoenix, AZ)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- Banner Health (Sun City, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… more
- Molina Healthcare (Phoenix, AZ)
- …knowledge on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or Bachelor's ... Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads… more
- Dignity Health (Phoenix, AZ)
- …role is for the Arizona and Nevada markets. Must have current Arizona unrestricted RN license.** The Utilization Management (UM) Manager is responsible for ... management department.( Utilization Management ,Denial Management ,Care Coordination) + Current unrestricted Arizona RN ...and review requirements + In-depth knowledge of utilization management processes and best practices +… more
- Humana (Phoenix, AZ)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Molina Healthcare (Phoenix, AZ)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- Molina Healthcare (Phoenix, AZ)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- CenterWell (Phoenix, AZ)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- HonorHealth (Phoenix, AZ)
- …3 years clinical experience in a hospital setting Required Licenses and Certifications Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal… more
- Molina Healthcare (Phoenix, AZ)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Guardian Life (Phoenix, AZ)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Sedgwick (Phoenix, AZ)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- CenterWell (Phoenix, AZ)
- …consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + ... for managing populations and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with travel requirements to… more
- Molina Healthcare (Phoenix, AZ)
- …on business need (up to 25%) **Job Qualifications** * Active and unrestricted Registered Nurse ( RN ) license or independent behavioral health license ... **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans...experience in health care * Understanding of clinical operations: utilization management , case management , etc.… more
- Molina Healthcare (Phoenix, AZ)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state… more
- Adelante (Phoenix, AZ)
- … Practitioner certificate issued by the Arizona Board of Nursing + Valid Arizona Registered Nurse license + Valid Arizona Advanced Practice license + Valid DEA ... Adult Nurse Practitioner Job Details Job Location Adelante Healthcare...the review of protocols and procedures + Review results of utilization and quality monitoring… more