- Molina Healthcare (Scottsdale, AZ)
- …standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Evolent (Phoenix, AZ)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... processing prior authorization requests in accordance with departmental...client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager,… more
- Molina Healthcare (AZ)
- … of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior - authorization , inpatient review) and ... Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care… more
- Molina Healthcare (Chandler, AZ)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
- Evolent (Phoenix, AZ)
- …teams and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and ... insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman).… more
- Molina Healthcare (Scottsdale, AZ)
- …United States who has a compact, multi-state license. This team reviews the prior authorization requests for transplants; the ideal candidate will have ... experience either in utilization review or case management for transplants....and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility… more
- Molina Healthcare (Chandler, AZ)
- …Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Evolent (Phoenix, AZ)
- …working seamlessly with diverse teams and stakeholders. + Deep understanding of prior authorization processes, reporting, and key performance indicators (eg, ... leadership is preferred. + Familiarity with value-based care models and utilization management frameworks is preferred. **Technical Requirements:** We require… more
- Humana (Phoenix, AZ)
- …MHA, MPH + Prior experience participating in teams focusing on quality management or utilization management . **Additional Information** Reports to a Lead ... . + Prefer Medical Hematology/Oncology specialties + Prefer Medicaid experience + Utilization management experience in a medical management review… more
- Copeland (Phoenix, AZ)
- …ensuring they meet employee needs and regulatory requirements.** **Vendor Relationship Management :** **Oversee and manage relationships with plan vendors, such as ... investment advisors and administrators, including sourcing, selection, and ongoing management of vendor partnerships.** **Retirement Investment Committee Support:** **Serve… more
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