Utilization Review Nurse - Mesa

Job Summary And Responsibilities · As our Utilization Management Nurse, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization. · Every day, you will meticul ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

Under the general direction of the Manager of Utilization Review, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources; promote quality patient care; assist with patient care management; comp ...

Performs criteria-based concurrent and retrospective utilization review to support efficient use of resources; promote quality patient care. · ...

We're hiring a Senior UM Review Nurse to join our Utilization Review team. · You will leverage clinical knowledge, judgment, · and established criteria to determine the medical appropriateness of healthcare services.Gather relevant medical information (via internal resources, tic ...

We're hiring a Nurse Supervisor to join our Utilization Review team. You will provide day-to-day oversight and management of the team including queue and volume throughput and staffing. · ...

The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients' needs. · ...

We are looking for a Registered Nurse with behavioral health experience to support the State of Arizona by providing compassionate care through virtual assessments and patient support. · Provide monitoring and technical assistance to ensure compliance with contractual obligations ...

Clinical Review & Appeals Specialist (RN/LVN) for Medix Healthcare in Tempe, AZ. Evaluates appeals related to insurance denials for air ambulance transports. · ...

Job Summary and Responsibilities · As our Utilization Management Nurse, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization. · Every day, you will meticul ...

This position is responsible for timely and accurate claims review and adjudication to avoid penalties, establishing and maintaining records and reports, interacting with claims personnel for review and assessing adjudication of work process, · Monitor, evaluate, and approve or d ...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel ...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel ...

Navitas Healthcare LLC seeks an experienced Registered Nurse RN to serve as Suicide Mortality Review Nurse Abstractor. · Competitive pay per hour. · ...

The Suicide Mortality Review Program conducts multidisciplinary reviews of suicide deaths to identify system gaps risk factors and prevention opportunities. · Review extract and summarize data from medical behavioral health social service autopsy and law enforcement records. · De ...

The primary purpose of your job position is to provide direct nursing care to the residents. · ...

Nurses at Banner Health enjoy some of the best on-the-job-training in the industry. We care about you, your nursing career today and your future. · ...

Primary City/State: · Mesa, Arizona · Department Name: · Perianesthesia -Hosp · Work Shift: · Evening · Job Category: · Nursing · Watch this short video to learn what it is like working in · Perioperative Services at Banner Desert Medical Center. · As a Registered Nurse RN, you w ...

Primary City/State: · Mesa, Arizona · Department Name: · PCU-4th Floor-Hosp · Work Shift: · Day · Job Category: · Nursing · $10,000 Hire On Bonus* · Better than ever for nurses. Banner Health recently earned Great Place To Work Certification. This recognition reflects our investm ...

Primary City/State: · Mesa, Arizona · Department Name: · PCU Neuro - 4A · Work Shift: · Day · Job Category: · Nursing · Great nursing careers start with great training. Nurses at Banner Health enjoy some of the best on-the-job-training in the industry. We care about you, your nur ...