utilization review jobs in Phoenix

TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization, inpatient and continued stay reviews, and presenting complex cases for Medical...

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.Required SkillsActive, unrestricted RN licensure from the United States in [state], OR,...

Job DescriptionPlease read the following job description thoroughly to ensure you are the right fit for this role before applying.PROJECT ENGINEER (Utilities) - Phoenix, AZThis role of Project Engineer is responsible for preparation of detailed design drawings and contract documents for water and wastewater infrastructure projects involving water supply...

The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team performance, accountability, and professional development by conducting regular 1:1s, managing performance reviews, and driving compliance with organizational, state, and federal requirements. The...

POSITION SUMMARY: The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in...

TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services.Responsibilities include preauthorization, inpatient and continued stay reviews, and presenting complex cases for Medical Director...

Job Summary Manages day-to-day construction activities, including supervision of craft employees and subcontractors. Schedules field activities in coordination with the project schedule. Is responsible for safety, production goals, quality control, and cost control. May supervise one or more craft groups and/or scopes of work. This position includes three...

Work at Home Part time JR- Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion...

The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team performance, accountability, and professional development by conducting regular 1:1s, managing performance reviews, and driving compliance with organizational, state, and federal requirements. The...

tango is a leader in the home health management industry and is preparing for significant growth! We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.We are currently looking for a Physician Reviewer to join our growing team on a full time basis. The Physician Reviewer provides...

Become a part of our caring community The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and frequently require...

Vice President of Bill Review Operations About the Company Innovative healthcare solutions provider specializing in insurance services Industry Insurance Type Privately Held Founded 2004 Employees 501-1000 Categories Insurance Specialties bill review out-of-network repricing primary ppo and alternative repricing administration edi and...

A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have a nursing license in Arizona and substantial experience in utilization review or case...

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,...

Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions...

tango is seeking a Physician Reviewer to join our remote, full-time team. You will perform real-time utilization management case reviews, apply evidence-based guidelines, and conduct peer-to-peer discussions with payers and physicians to determine medical necessity for home health services. You will collaborate with provider relations and clinical management...

Job Description Meade is seeking a talented Senior Protection & Control (P&C) Engineer to lead and execute medium- to high-voltage (15kV to 500kV) substation protection and control design projects. This is a technical, detail-focused role ideal for engineers who excel in high-paced environments and are experienced in producing code-compliant, constructible...

PROJECT ENGINEER (Utilities) - Phoenix, AZ This role of Project Engineer is responsible for preparation of detailed design drawings and contract documents for water and wastewater infrastructure projects involving water supply (wells), distribution systems and collection systems, as well as storage tanks, booster stations and sewer lift stations. This role...

Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Key Details: Must be a Board Certified Physician and licensed in the state of Arizona. - Provides medical leadership of all for utilization management, cost containment, and medical...

The position provides comprehensive care coordination for patients as assigned and assesses the patients plan of care. The Case Manager is responsible for Length of Stay management and discharge planning. Develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, advocating and facilitating...