- Molina Healthcare (Chandler, AZ)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines.… more
- CVS Health (Phoenix, AZ)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- Banner Health (Phoenix, AZ)
- …delivery, focusing on value-based care, risk recapture, and quality outcomes. This role includes medical case review , utilization , and quality review , ... an environment of quality care and efficiency + Conduct medical case reviews, utilization and quality assessments,...and efficiency + Conduct medical case reviews, utilization and quality assessments, and make strategic recommendations for… more
- HonorHealth (AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation,… more
- Sedgwick (Flagstaff, AZ)
- …Fortune Best Workplaces in Financial Services & Insurance Physical Therapy Utilization Review Advisor **PRIMARY PURPOSE** **:** Counsels providers (physical ... updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and… more
- CVS Health (Phoenix, AZ)
- …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
- CVS Health (Phoenix, AZ)
- …5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Humana (Phoenix, AZ)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... our most vulnerable members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations… more
- Molina Healthcare (Chandler, AZ)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more