- Evolent (Phoenix, AZ)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical 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 ... + Provides clinical 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 ... and provides clinical 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 ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Highmark Health (Phoenix, AZ)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities...care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy… more
- Humana (Phoenix, AZ)
- …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Travelers Insurance Company (Phoenix, AZ)
- …other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay apprised of ... influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State… more
- Humana (Phoenix, AZ)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… 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 , ... clinical staff, fostering an environment of quality care and efficiency + Conduct medical case reviews, utilization and quality assessments, and make strategic… 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