- 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)
- …in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and clinical ... for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to … more
- CVS Health (Phoenix, AZ)
- …nursing facility. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... for members. **Position Summary** Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to … more
- CVS Health (Phoenix, AZ)
- …+ Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll play a vital role… 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 ... healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the… more
- HonorHealth (AZ)
- …it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… 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 studies through coordination of the… 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 ... maintenance of department logs and databases, department statistics, and utilization review documents according to hospital policy and state/ federal regulations.… 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 ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more