- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... 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
- CenterWell (Phoenix, AZ)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Phoenix, AZ)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CVS Health (Phoenix, AZ)
- …a team that's making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in ... 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
- Centene Corporation (Phoenix, AZ)
- …on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken… more
- Molina Healthcare (Scottsdale, AZ)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. +… more
- Molina Healthcare (Chandler, AZ)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Scottsdale, AZ)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Phoenix, AZ)
- …stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to Molina ... by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not… more
- Molina Healthcare (Scottsdale, AZ)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease ... productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more