- CenterWell (Phoenix, AZ)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Molina Healthcare (Scottsdale, AZ)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Humana (Phoenix, AZ)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Nurse 2 work… more
- Molina Healthcare (Mesa, AZ)
- …**Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...intensive care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours: Monday… more
- CVS Health (Phoenix, AZ)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll ... be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...+ Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams… more
- ERP International (Yuma, AZ)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager** for a full-time position at the Camp Pendleton **Branch Health Clinic** in ... such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.… more
- CVS Health (Phoenix, AZ)
- …the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers… more
- Humana (Phoenix, AZ)
- …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
- Humana (Phoenix, AZ)
- …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
- Highmark Health (Phoenix, AZ)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and… more
Recent Jobs
-
Analyst, Asset Management
- Brookfield Properties (Atlanta, GA)
-
Sr. Principal Chief Engineer/Integrated Product Team (IPT) Lead
- Northrop Grumman (Baltimore, MD)
-
Senior Director, Marketing and Product Management - Microbiology
- Danaher Corporation (West Sacramento, CA)