- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Molina Healthcare (Chandler, 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). **WORK SCHEDULE: Mon - Fri / Sun… more
- Dignity Health (Phoenix, AZ)
- … 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
- 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
- Sharecare (Phoenix, AZ)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Highmark Health (Phoenix, AZ)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… 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 ... position provides nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is accountable for the quality of nursing… more
- Molina Healthcare (Mesa, AZ)
- …and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and...them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and… 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
- HonorHealth (Phoenix, AZ)
- …Required Experience 3 to 5 years of CDI experience Required Licenses and Certifications Nursing\ RN - Registered Nurse - State Licensure And/Or Compact State ... but not limited to the Clinical Effectiveness Committee, monthly facility specific Utilization Review Committees and Chief Medical Officers reports. Conducts… 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
- Evolent (Phoenix, AZ)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- CVS Health (Phoenix, AZ)
- …preferred in social work, psychology, special education, or counseling, or be a licensed registered nurse . **Pay Range** The typical pay range for this role is: ... utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… 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 ... Family Nurse Practitioner Job Details Job Location Adelante Healthcare...the review of protocols and procedures + Review results of utilization and quality monitoring… more
- Molina Healthcare (Mesa, AZ)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... of the following key Healthcare Services functions: case management /disease management /care transitions; utilization management (Position oversees PA… more