- CenterWell (Phoenix, AZ)
- …Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- CenterWell (Phoenix, AZ)
- …or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Centene Corporation (Phoenix, AZ)
- …including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Molina Healthcare (Chandler, AZ)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Banner Health (Tucson, AZ)
- …provider networks, and regulatory agencies. Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... that promote a healthy work-life balance. As the Registered Nurse RN Case Manager Care Coordination, you will have...across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients… more
- Banner Health (Sun City West, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... and fulfilment of their employees. As a RN Registered Nurse Case Manager of Care Coordination, you will contribute...across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients… more
- Banner Health (Phoenix, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... the plan across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients with discharge planning… more
- Banner Health (Phoenix, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... the plan across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients with discharge planning… more
- Banner Health (Queen Creek, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the completion of a ... the plan across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients with discharge planning… more