- Centene Corporation (Phoenix, AZ)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- CVS Health (Phoenix, AZ)
- …+ 1 year of varied UM (utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety ... + 1 year of varied UM (utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education**… more
- CVS Health (Phoenix, AZ)
- …Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient ... experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and … more
- CVS Health (Phoenix, AZ)
- …Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient ... nursing facility. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and … more
- CVS Health (Phoenix, AZ)
- …role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position ... facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll play...of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+… more
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role,...In this role, you'll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to… more
- HonorHealth (AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- HonorHealth (AZ)
- …RN's, registrars, trauma surgeons and other sub-specialist to organize document the concurrent review processes along with the complete follow-up performance ... improvement activity including loop closure. Assist the trauma research nurse and TMD in the implementation of clinical... nurse and TMD in the implementation of clinical studies through coordination of the administrative and … more
- Molina Healthcare (Scottsdale, AZ)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- HonorHealth (AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more