- Evolent (Phoenix, AZ)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Humana (Phoenix, AZ)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Humana (Phoenix, AZ)
- …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Community Health Systems (Oro Valley, AZ)
- …administration of the activities of clinical review , discharge planning, resource utilization and utilization review . Candidates need acute hospital ... to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to… more
- Humana (Phoenix, AZ)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Molina Healthcare (Chandler, AZ)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- CenterWell (Phoenix, AZ)
- …potential market events that would drive unanticipated changes in cost and utilization . The team also leads our trend detection process, responsible for identifying ... month, quarter over quarter and year over year trend review and ad hoc as needed + Proactively monitors...time that is best for your schedule **Work at Home requirements:** To ensure Home or Hybrid… more
- Evolent (Phoenix, AZ)
- …developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk- based models.** + Process ... role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to… more
- ERP International (Luke AFB, AZ)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... of care delivery processes, to include alternate healthcare settings and the home environment, for the purposes of enhancing the patient's health and wellness,… more
- Humana (Phoenix, AZ)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance organizations,… more
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