- CVS Health (Phoenix, AZ)
- …role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position ... facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, you'll play...of experience in Oncology and Transplant either in UM, concurrent review , or prior authorization + 3+… more
- HonorHealth (AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
- CVS Health (Phoenix, AZ)
- …outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and ... Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role,...In this role, you'll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to… more
- Banner Health (AZ)
- …thoroughly completes documentation required for claims payment of services approved through concurrent review 2. Supervises the team to ensure internal/external ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
- Molina Healthcare (Tucson, AZ)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more
- Molina Healthcare (Phoenix, AZ)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- Molina Healthcare (Mesa, AZ)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more