- 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)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Phoenix, AZ)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CVS Health (Phoenix, AZ)
- …that promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. ... In this role, you'll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- CenterWell (Phoenix, AZ)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Dignity Health (Gilbert, AZ)
- …and Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is...clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Evolent (Phoenix, AZ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Molina Healthcare (Phoenix, AZ)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… 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
- Banner Health (Phoenix, AZ)
- …, acute care and/or home care environments, community resources and resource/ utilization management . Must demonstrate critical thinking skills, problem-solving ... networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the… 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 ... **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care This position is eligible for a $10,000...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Mayo Clinic (Phoenix, AZ)
- …by ensuring appropriate utilization management , care coordination, resource utilization , and clinical documentation. The RN Case Manager will function ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, and… more
- Banner Health (Phoenix, AZ)
- …Phoenix, Arizona **Department Name:** Addiction Medicine **Work Shift:** Day **Job Category:** Clinical Care At Banner - University Medical Center, we're creating a ... will serve as primary patient and caregiver contact for education, symptom management , and care plan adherence, coordinate care across inpatient, outpatient, and… 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 ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Banner Health (Phoenix, AZ)
- …and clinical support to patients and staff. Uses depth and breadth of clinical management knowledge to ensure the provision of high quality, safe, and cost ... the unit to ensure smooth and efficient patient care management and resource utilization . 2. Leads change...management as normally demonstrated through two years of clinical management experience relevant to patient population.… more
- CVS Health (Phoenix, AZ)
- …8:00am - 5:00pm in time zone of residence **Preferred Qualifications** - Utilization Management review - Managed Care experience **Education** Associates degree ... each and every day. **Position Summary** As a QM Nurse Consultant you will be responsible for the review...will be responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets… 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 ... Arizona **Department Name:** Family Medicine-Raintree **Work Shift:** Day **Job Category:** Clinical Care A rewarding career that fits your life. Those who… more
- Dignity Health (Gilbert, AZ)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year...+ Collaborate effectively with multiple stakeholders + Understand how utilization management and case management … more
- Banner Health (Phoenix, AZ)
- …Arizona **Department Name:** BUMCP Cardiovascular **Work Shift:** Day **Job Category:** Clinical Care At Banner - University Medical Center, we're creating a ... are of the utmost importance. Experience: Specialty based Experience: Clinical knowledge regarding Structural Heart, knowledge of related CMS guidelines/registry… more
- Banner Health (Phoenix, AZ)
- …Arizona **Department Name:** C/P-Support Services-Clinic **Work Shift:** Day **Job Category:** Clinical Care Nursing careers are better at Banner Health. We've built ... academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly… more
