- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management** in support of the56th Medical Group at Luke AFB, AZ… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or...year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and… more
- CenterWell (Phoenix, AZ)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Humana (Phoenix, AZ)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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
- CVS Health (Phoenix, AZ)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Evolent (Phoenix, AZ)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Banner Health (Phoenix, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health… more
- Banner Health (Sun City, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of the health… 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...Contributes to plan of care under direction of registered nurse , including the discharge plan, utilizing assessment data and… more
- Molina Healthcare (Phoenix, AZ)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Phoenix, AZ)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Phoenix, AZ)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- Molina Healthcare (Phoenix, AZ)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Highmark Health (Phoenix, AZ)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Select Medical (Phoenix, AZ)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... Management** **Full Time: Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3)… more
- Town of Gilbert (Gilbert, AZ)
- …- 2 years + 3 - 4 years + 5+ years 04 Are you a certified paramedic, registered nurse or licensed practical nurse ? + Yes + No 05 How many years of experience do ... 06 Describe your experience related to quality assurance (QA) review related to patient care reports and ambulance billing....NA. 14 Please describe your work experience involving ambulance utilization and deployment. if you do not have experience… more
- Fresenius Medical Center (Phoenix, AZ)
- …dialysis clinic. You will collaborate with the Medical Director and the Charge Nurse regarding the provision of quality patient care in the dialysis clinic. ... data collections and auditing activities. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review… more
- Oracle (Phoenix, AZ)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more
