- Baylor Scott & White Health (Phoenix, AZ)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Banner Health (Mesa, 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 ... could be the perfect opportunity for you. As the RN Case Manager, you will bring your experience and...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… more
- Molina Healthcare (Phoenix, AZ)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- HonorHealth (Scottsdale, AZ)
- …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews...from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting.… 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 ... the community.** Our highly skilled team includes experienced bedside registered nurses, licensed nursing assistants, Neonatologists, NNP, Respiratory Therapist,… more
- Highmark Health (Phoenix, AZ)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Dignity Health (Mesa, AZ)
- …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… 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
- Banner Health (Phoenix, AZ)
- …quality management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission ... Banner Estrella, you will be guided by the primary RN on duty. This LPN needs experience in an...nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is… 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
- 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
- Banner Health (Mesa, AZ)
- …evidenced-based, high-quality clinical care outcome focused, and solution oriented. The Registered Nurse Associate Director position is a full-time day ... health care advancements and excellent patient care. As the RN Associate Director Neuro PCU, you will bring your...the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change… more
- Molina Healthcare (Phoenix, AZ)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… 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
- CVS Health (Phoenix, AZ)
- …Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Applies critical thinking and knowledge in ... resources. Evaluation of Members; Through the use of care management tools and information/data review , conducts comprehensive...reimbursement policy + 2+ years clinical experience as a RN + 2+ years of case management ,… more
- Centene Corporation (Phoenix, AZ)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse preferred Pay Range: $26.50 - $47.59 per ... workplace flexibility. **Must have Arizona LPN license or Compact RN license.** **Position Purpose:** Analyzes all prior authorization requests... utilization management processes preferred.… more
- Centene Corporation (Phoenix, AZ)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… 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
- Centene Corporation (Tempe, AZ)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Conduct review of delegated entities for compliance with quality, service performance ... and utilization , credentialing reviews and medical record audits. Perform community...Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care… more