- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management with ... **Overview** ERP International is seeking a full time **Registered Nurse - Case Management ** in support of the56th Medical Group at Luke AFB, AZ… more
- Humana (Phoenix, AZ)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- CenterWell (Phoenix, AZ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Phoenix, AZ)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Molina Healthcare (Phoenix, AZ)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… more
- Corning Incorporated (Phoenix, AZ)
- …and time management skills. + Great computer skills and EMR utilization **Desired Qualifications:** + Certified Occupational Health Nurse (COHN | COHN-S) ... Occupational Health Nurse **Date:** Dec 11, 2025 **Location:** Phoenix, AZ,...connect the unconnected, drive the future of automobiles, transform at- home entertainment, and ensure the delivery of lifesaving medicines.… more
- Evolent (Phoenix, AZ)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Banner Health (Phoenix, AZ)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the ... beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Banner Health (Phoenix, AZ)
- …nursing judgement to support and coordinate the complex needs of patients. The Nurse Navigator is continuously assessing for barriers to care and addressing them by ... at least 2 years in pulmonology, or chronic disease management . Other background that would assist in being successful...beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with… 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...LVN in the specialty area. Employees working for Banner Home Care AZ must possess an Arizona Fingerprint Clearance… more
- Banner Health (Phoenix, AZ)
- …will serve as primary patient and caregiver contact for education, symptom management , and care plan adherence, coordinate care across inpatient, outpatient, and ... oversee ambulatory detox monitoring, specialty medication administration (Vivitrol), lab management , and medication reconciliation, support efforts to reduce readmissions… more
- Banner Health (Phoenix, AZ)
- …has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona ... the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating… more
- Molina Healthcare (Phoenix, AZ)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… 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
- Sharecare (Phoenix, AZ)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Banner Health (Phoenix, AZ)
- …changes and improvements with a primary focus on patient outcomes. Oversees resource utilization regarding staff, fiscal management , and quality patient care. 4. ... has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona… more
- ZOLL Medical Corporation (Phoenix, AZ)
- …medical device technology company that focuses on the development and manufacturing of Home Sleep Apnea Tests to aid in the diagnosis of respiratory sleep disorders. ... Our core product is the WatchPAT(R)️ family, a revolutionary FDA-cleared portable home sleep apnea test device, that is based on proprietary signal and analysis. 80%… more
- Molina Healthcare (Phoenix, AZ)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… 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. ... Human Resources, Quality, and Technical Services departments. + Collaborates with the Home Therapies Manager to oversee the facility's Home Therapies Program.… more
