- Highmark Health (Phoenix, AZ)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Highmark Health (Phoenix, AZ)
- …itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education ... successful and measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes qualitative and… more
- Highmark Health (Phoenix, AZ)
- …agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees. ... designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret… more
- Highmark Health (Phoenix, AZ)
- …internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy and ... Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required....position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Adelante (Surprise, AZ)
- …Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations POSITION REPONSIBILITIES Health Care Delivery + ... Womens Health Nurse Job Details Job Location Adelante Healthcare...review of protocols and procedures + Review results of utilization and quality monitoring and participate in the analysis… more
- Adelante (Phoenix, AZ)
- …Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations POSITION REPONSIBILITIES + Reports to the Regional Medical ... Womens Health Nurse Practitioner - West Phoenix Job Details...review of protocols and procedures + Review results of utilization and quality monitoring and participate in the analysis… more
- Banner Health (Tucson, AZ)
- …Integrated Psychosocial Assessment for Transplant (SIPAT) and/or Psychosocial assessments, behavioral observations, evidence-based mental health and substance ... Category:** Clinical Care Great careers are built at Banner Health . There's more to health care than...out-of-pocket expenses. 4. Develops, implements, monitors, and documents the utilization of resources and progress of the patient through… more
- Veterans Affairs, Veterans Health Administration (Prescott, AZ)
- …a timely response to individuals in psychosocial crisis as well as supporting the behavioral health needs of those in crisis. Coordinator will collaborate with ... GS-12 grade level and is administratively responsible for the Northern Arizona VA Health Care System (NAVAHCS) Spinal Cord Injury and Disorder program. The program… more
- Banner Health (Sun City West, AZ)
- …**Work Shift:** Day **Job Category:** Clinical Care You have a place in the health care industry. If you're looking to leverage your abilities to make a real ... difference - and real change in the health care industry - you belong at Banner ...services are vital to patient outcomes, patient experience and efficiency/ utilization to ensure proper throughout. Seize the opportunity to… more
- CVS Health (Scottsdale, AZ)
- …Compliance to ensure equitable application of UM across medical/surgical and behavioral health therapies. **Regulatory Strategy & Compliance** + Facilitate ... At CVS Health , we're building a world of health...for Medical Affairs. This includes accountability and support for utilization management (UM), formulary development, regulatory audits and clinical… more