- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... in an acute care setting. Required 1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse (RN) State And/Or Compact… more
- Molina Healthcare (Mesa, AZ)
- …Responsible for the development, implementation, and delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. Leads ... SKILLS & ABILITIES** : + 2 or more years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of… more
- Humana (Phoenix, AZ)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… 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 (Scottsdale, 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
- Adelante (Surprise, AZ)
- …audits, continuing education, and the review of protocols and procedures + Review results of utilization and quality monitoring and participate in the ... Adult Nurse Practitioner Job Details Job Location Adelante Healthcare...providing comprehensive primary health care services through the identification, management and/or referral of the health problems and the… more
- Humana (Phoenix, AZ)
- …licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Molina Healthcare (Scottsdale, AZ)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Phoenix, AZ)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- Banner Health (Gilbert, AZ)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through ... pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of...the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse… more
- Adelante (Mesa, AZ)
- Adult Nurse Practitioner - Mesa Job Details Job Location...the review of protocols and procedures + Review results of utilization and quality monitoring ... Adelante Healthcare Mesa - Mesa, AZ Position Type Exempt Education Level NP ( Nurse Practitioner) Job Category Health Care Description POSITION SUMMARY The Adult … more
- Banner Health (Mesa, AZ)
- …you're looking to leverage your abilities - apply today. **As a Registered Nurse Support Operations Specialist, you will provide support for the PAT and Adult/Peds ... Our Endoscopy Unit maintains 6 procedural rooms, along with utilization of the OR, as needed. Nursing careers are...when applicable** **.** If you are a New Graduate Nurse with less than 12 months of experience, please… more
- Banner Health (Phoenix, AZ)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through ... pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of...the completion of a bachelor's degree in case management or health care. Requires current Registered Nurse… more
- Banner Health (Mesa, AZ)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... team drives high clinical outcomes, excellent experience, and effective resource utilization . The role actively participates in department and facility wide… more
- Banner Health (Mesa, AZ)
- …the operations of the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change by developing, implementing and ... service skills, and flexibility. Congruence of perceptions in the nurse -patient relationship and therapeutic communications are essential characteristics. Your pay… more
- Molina Healthcare (Scottsdale, AZ)
- …authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Molina Healthcare (Phoenix, 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
- Evolent (Phoenix, AZ)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Molina Healthcare (Scottsdale, AZ)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management… more
- CenterWell (Phoenix, AZ)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more