ume jobs in Phoenix

Registered Nurse (RN) - Utilization ManagementMake an impact on patient care while working in a dynamic, collaborative environment. We're seeking an experienced Registered Nurse (RN) to join our Utilization Management team, where you'll help ensure members receive the right care at the right time through evidence-based clinical review and care...

Registered Nurse (RN) - Utilization ManagementWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything...

Avsis is seeking an Utilization Management Administrative Support professional to assist in data entry, correspondence, and clerical duties across the UM department.Find out more about the daily tasks, overall responsibilities, and required experience for this opportunity by scrolling down now.You will liaise with provider offices to collect missing...

Medical DirectorOptum 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 their best. Here, you will find a culture guided by inclusion,...

Medical DirectorOptum 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 their best. Here, you will find a culture guided by inclusion,...

Humana, Inc. is seeking a Senior Workforce Management Professional to join the Pharmacy Process Engineering team. The role blends advanced analytics with day-to-day workforce management to optimize staffing, learning, and compliance for Medicaid UM, while supporting enterprise planning and operational execution. You will forecast staffing needs, oversee...

tango in Phoenix, AZ seeks a UM Clinical Support Specialist to support Utilization Management through data collection, reporting, and administrative tasks. You will help maintain logs, develop reports, and assist reviewers with obtaining clinical information while supporting compliance and appeals processes. Ideal candidates have an associate degree in...

You must reside in one of the following states for this position: AL, AR, AZ, GA, IA, ID, IL, IN, KS, KY, LA, MI, MO, MS, NY, OH, OK, PA, SC, TN, TX, UT, WIAmerican Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care...

Become a part of our caring community Become a part of our caring community The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent...

Brief Description tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost...

Humana, Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and related documentation ensuring adherence to policies and regulations. The role requires bilingual English/Spanish proficiency and capability to pass required examinations. You will collect and analyze data to measure outcomes and operational metrics for...

Avsis is seeking an Utilization Management Administrative Support professional to assist in data entry, correspondence, and clerical duties across the UM department. You will liaise with provider offices to collect missing information and prepare communications for enrollees and providers. The role emphasizes timely, compliant document handling and...

Humana, Inc. is seeking a Senior Workforce Management Professional to join the Pharmacy Process Engineering team.The role blends advanced analytics with day-to-day workforce management to optimize staffing, learning, and compliance for Medicaid UM, while supporting enterprise planning and operational execution. You will forecast staffing needs, oversee...

Senior Associate Dean, Office of Undergraduate Medical Education (UME) (Updated) The University of Arizona College of Medicine – Phoenix seeks a motivated and visionary leader to serve as the senior associate dean for the Office of Undergraduate Medical Education (UME). The senior associate dean of UME reports directly to the executive vice dean of the...

Highmark Health is seeking a full-time RN Care Manager for a REMOTE role requiring weekend availability (Saturday and Sunday) and three weekdays. The position focuses on utilization management, coordinating care, and improving provider and member satisfaction through data-driven strategies. Responsibilities include implementing review processes, educating...

Integra Partners seeks an LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews for DMEPOS. You will collaborate with the Medical Director on benefit and medical necessity decisions within a NCQA-compliant UM program. The role involves applying federal and state mandates, plan benefit language, and criteria such...

Job Requirements JOB SUMMARY: A clinically competent professional who utilizes the nursing process to direct and deliver care to the patient population in the primary care office setting. LOCATION: Danny and Gail Jones, Primary Care, Bel Air 542 W Macphail Rd, Bel Air, MD 21014 The primary care team at UM Upper Chesapeake Health is committed to helping...

Humana, Inc. is seeking a Senior Workforce Management Professional to join the Pharmacy Process Engineering team. The role blends advanced analytics with day-to-day workforce management to optimize staffing, learning, and compliance for Medicaid UM, while supporting enterprise planning and operational execution. You will forecast staffing needs, oversee...

Job RequirementsJob DescriptionSIGN ON BONUS OFFERED! - Up to $10K!!This is a Night Shift Role.Full time – 7p – 7:30a with every 3rd weekendEvery Patient. Every Encounter. Every Day.At University of Maryland Upper Chesapeake Health (UM UCH), you will join a highly dedicated and supportive team that has been providing high quality care to the community of...

Healthcare Payer Consultant - QNXT Location: Remote Employment Type: Full-Time Job ID: 00070835941 About the role As a QNXT UM/A&G Consultant , you will make an impact by helping healthcare payers optimize member and provider communications through effective utilization management and appeals & grievances correspondence solutions. You will be a valued member...