- 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 (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). **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
- 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
- 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
- CVS Health (Phoenix, AZ)
- …weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Utilization Management is a 24/7 operation.** 100% attendance is required ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...with 100% participation during 8:30am-5pm Monday-Friday EST + A Registered Nurse that must hold an unrestricted… more
- CVS Health (Phoenix, AZ)
- …on weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Utilization Management is a 24/7 operation.** Travel Required up to 5% ... meetings/audits The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible...department + 3+ years inpatient clinical experience as a Registered Nurse + 3+ years of Managed… 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 (Phoenix, 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
- Molina Healthcare (Phoenix, AZ)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… 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
- 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
- Molina Healthcare (Phoenix, AZ)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...Integrated DSNP Medicare and Medicaid model that ensures case management and utilization management work… 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
- 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