- CenterWell (Phoenix, AZ)
- …consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + ... and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with...organization. This must include the ability to drive a team- based approach and work as an interdisciplinary team to… more
- Evolent (Phoenix, AZ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Phoenix, AZ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Phoenix, AZ)
- …business needs of the particular health plan. * Research requests for post-determination review and categorizes each for processing based on the applicable ... You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Banner Health (AZ)
- …for this position is M-F 40 hours a week (full time exempt position). You will be based from home with monthly on site meetings in Chandler with Team. In this ... use variation and costs through the development of consensus supply utilization programs and initiatives. Responsible for clinical and related operational financial… more
- CommonSpirit Health (Phoenix, AZ)
- …million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital- based locations, in addition to its home - based services and ... **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical...to all constituents. **Key Responsibilities** + Conducts medical record review in appropriate cases for medical necessity of inpatient… more
- Evolent (Phoenix, AZ)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Phoenix, AZ)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job ... Reviewer you will be a key member of the utilization management team. We can offer you a meaningful...needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not… more
- CenterWell (Phoenix, AZ)
- …medical guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and ... care being provided meets appropriate standards and to ensure cost-effective utilization practices. + Oversee the development, revision, and implementation of… more
- Humana (Phoenix, AZ)
- …and/or experience with medical terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied...organization **Work-At- Home Requirements** To ensure … more