- Fresenius Medical Center (Tucson, AZ)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- CVS Health (Phoenix, AZ)
- …Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review of fraud, waste, and abuse for individual ... Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for ...based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols. + Serve… 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 ... clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications… more
- CenterWell (Prescott, AZ)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Highmark Health (Phoenix, AZ)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
- CVS Health (Phoenix, AZ)
- …Case management and discharge planning experience + Crisis intervention skills + Managed care/ utilization review experience + Ability to take and manage crisis ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- SARGENT AEROSPACE & DEFENSE (Tucson, AZ)
- …technologies to improve process capability, and increase process controls + Review engineering designs and documentation for manufacturability + Define manufacturing ... drawings, procedures and ensure blue print compliance + Advanced Knowledge and utilization of GD&T, schematics and relevant test and inspection equipment + Advanced… more
- Evolent (Phoenix, AZ)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... Nurse, you will be a key member of the utilization management team. We can offer you a meaningful...other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions… more
- Evolent (Phoenix, AZ)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... Nurse, you will be a key member of the utilization management team. We can offer you a meaningful...other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions… more
- Community Health Systems (Oro Valley, AZ)
- …administration of the activities of clinical review , discharge planning, resource utilization and utilization review . **Essential Functions** + Conducts ... patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and… more