- Humana (Phoenix, AZ)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- 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
- 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.... management , and budget control. Departments involved are Utilization Management , Case Management , and… 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
- Adelante (Phoenix, 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
- 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)
- …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)
- …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 (Phoenix, AZ)
- …quality management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission ... 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
- Dignity Health (Phoenix, AZ)
- …of RN Program. + (3-5) Three to five years-clinical RN experience. + Two years Utilization Review Charge Audit Case Management or related experience. + RN ... + Knowledge of hospital billing and charging processes and understanding of Medical Terminology. + Understanding of rules and guidelines to include American Association of Medical Audit Specialists (AAMAS) and National Commission on Insurance Guidelines 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
- CVS Health (Phoenix, AZ)
- …management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases ... AM to 5:00 PM Arizona Time zone. The Care Management Associate (CMA) supports comprehensive coordination of medical services...and either approve or send to nursing staff for review . Additional responsibilities to include but not limited to… 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
- Evolent (Phoenix, AZ)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … 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 ... clinical care outcome focused, and solution oriented. The Registered Nurse Associate Director position is a full-time day shift...that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of… more
- Intermountain Health (Phoenix, AZ)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- Banner Health (Sun City, 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
- HonorHealth (Phoenix, AZ)
- …in the maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal ... of care needs daily and coordinates transition to next level of case management or care coordination services. Performs concurrent review of patient treatment… more
- Molina Healthcare (Phoenix, AZ)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... vessels and cardiovascular disease. Privileges include ACLS cardioversion; insertion and management of central venous and pulmonary artery catheters; use of… more