- Humana (Phoenix, AZ)
- …**3+ years of Skilled Nursing Facility experience and or Previous experience in utilization management** + Prior clinical experience preferably in an acute care, ... part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Molina Healthcare (Tucson, AZ)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Evolent (Phoenix, AZ)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- CVS Health (Phoenix, AZ)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate,… more
- Evolent (Phoenix, AZ)
- …with health care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred + ... and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and design system… more
- CenterWell (Phoenix, AZ)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- CenterWell (Phoenix, AZ)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Molina Healthcare (Scottsdale, AZ)
- …holidays.** Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Adecco US, Inc. (Phoenix, AZ)
- …. Serve as a clinical resource working from a computer, reviewing prior authorizations and receiving phone calls from prior authorization pharmacy ... clinical questions, interpret guideline criteria, and provide decisions on prior authorization requests. Ensure determinations are clinically sound, evidence-based,… more
- Molina Healthcare (Mesa, AZ)
- …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more