- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Phoenix, AZ)
- …we do it all with heart, each and every day. **Position Summary** The ** Utilization Management Clinical Nurse Consultant** utilizes clinical skills to ... Arizona Time Zone. **Preferred Qualifications** : + Previous experience with utilization management . + Previous clinical experience in Emergency Department,… 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
- 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 ... use of resources; promote quality patient care; assist with patient care management ; comply with applicable standards and regulations and provide information and… more
- 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
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Veterans Affairs, Veterans Health Administration (Scottsdale, AZ)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... Summary The Clinical Registered Nurse position is located within Ambulatory Care service...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… 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
- Molina Healthcare (Phoenix, AZ)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Mayo Clinic (Phoenix, AZ)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, 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
- Corning Incorporated (Glendale, AZ)
- …and time management skills. + Great computer skills and EMR utilization **Desired Qualifications:** + Certified Occupational Health Nurse (COHN | COHN-S) ... Occupational Health Nurse **Date:** Nov 12, 2025 **Location:** Glendale, AZ,...processing of work-related illnesses or injuries. Ensure effective case management . + Absence management - utilize Corning's… 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 ... pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of...completion of a bachelor's degree in case management or health care. Requires current Registered … more
- Banner Health (Glendale, AZ)
- …behaviors each and every day. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion ... pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. 6. Educates internal members of...of a bachelor's degree in case management or health care. Requires current Registered … more
- Banner Health (Phoenix, AZ)
- … management process. Reviews audit results and presents summary information for management utilization and review. 7. May coordinate the admission process ... facilities in the Phoenix Metro area. Exemplars mentioned from the American Nurse Credentialing Center included the robust nursing succession planning and the… more
- Banner Health (Gilbert, AZ)
- …POSITION SUMMARY This position provides administrative supervision of campus workflow, resource utilization and management , and operations for all clinical and ... and receive care. Clinical Care Operations is the hub of patient management for the campus, including: bed assignment, unit staffing (scheduling, balancing, casual… more
- Banner Health (Phoenix, AZ)
- …weekends, holidays, mid-shifts or nights and no on call requirement. The Nurse Navigator works collaboratively to remove barriers for their specialty patients, ... or experience in: navigation, complex care coordination, or case management and the ability and willingness to learn new...of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through… more
- Evolent (Phoenix, AZ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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