- 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
- 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 (Surprise, 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
- 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
- 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