• Care Review Clinician ( RN )

    Molina Healthcare (Tucson, AZ)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Care Review Clinician RN (BH Licensed)

    Molina Healthcare (AZ)
    …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management ( UM ) policies and procedures. * May work collaboratively with ... collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit. Required… more
    Molina Healthcare (11/21/25)
    - Related Jobs

  • Utilization Management Nurse…

    CVS Health (Phoenix, AZ)
    …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We...computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM… more
    CVS Health (10/31/25)
    - Related Jobs

  • Denials Prevention Specialist, Clinician PRN

    Datavant (Phoenix, AZ)
    …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus. Minimum… more
    Datavant (11/12/25)
    - Related Jobs

  • Clinical Reviewer, Nurse…

    Evolent (Phoenix, AZ)
    …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of...under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the… more
    Evolent (11/20/25)
    - Related Jobs

  • Nurse Care Coordination

    Dignity Health (Gilbert, AZ)
    … RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ), or UM Certification Training: + Knowledge of managed care and payer ... **Job Summary and Responsibilities** The Care Coordination Department at Mercy Gilbert Medical Center plays a critical role in providing exceptional patient care to… more
    Dignity Health (11/15/25)
    - Related Jobs

  • Nurse Utilization Review

    Dignity Health (Gilbert, AZ)
    …of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ), or UM Certification **Where You'll Work** Hello humankindness ... Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to support… more
    Dignity Health (11/21/25)
    - Related Jobs

  • Nurse Utilization Review

    Dignity Health (Chandler, AZ)
    …of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ), or UM Certification **Where You'll Work** **Hello Humankindness ... Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to support… more
    Dignity Health (11/21/25)
    - Related Jobs

  • Transplant Care Nurse (Remote)

    Highmark Health (Phoenix, AZ)
    …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
    Highmark Health (11/06/25)
    - Related Jobs

  • Manager, Business Compliance

    CVS Health (Phoenix, AZ)
    …years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management ( UM ) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
    CVS Health (11/19/25)
    - Related Jobs