- Molina Healthcare (Phoenix, 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). **MULTI STATE / COMPACT… 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
- Banner Health (Sun City West, AZ)
- …of a bachelor's degree in case management or health care. Requires current Registered Nurse ( RN ) license in state worked. For assignments in an ... be the opportunity you've been waiting for. As an RN Case Manager, you will contribute your expertise and...regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as… 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 ... Banner Estrella, you will be guided by the primary RN on duty. This LPN needs experience in an...nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is… 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 ... caring for patients with wounds. We use a case management model to help patients navigate through the complex...nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is… more
- Banner Health (Glendale, AZ)
- …quality management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission ... maintain safe quality care? Do you have excellent time management and critical thinking skills? Are you; teamwork oriented,...nursing care under the direction and supervision of a registered nurse and/or licensed physician, and is… 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
- 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
- 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
- Centene Corporation (Phoenix, AZ)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse preferred Pay Range: $26.50 - $47.59 per ... workplace flexibility. **Must have Arizona LPN license or Compact RN license.** **Position Purpose:** Analyzes all prior authorization requests... utilization management processes preferred.… more
- Centene Corporation (Phoenix, AZ)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Adelante (Surprise, AZ)
- … Practitioner certificate issued by the Arizona Board of Nursing + Valid Arizona Registered Nurse license + Valid Arizona Advanced Practice license + Valid DEA ... Adult Nurse Practitioner Job Details Job Location Adelante Healthcare...the review of protocols and procedures + Review results of utilization and quality monitoring… more