18 utilization review case manager jobs at 13 companies in Arizona
2w
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Utilization Review Coordinator
Phoenix, Arizona, United States
OnsiteFull Time
High school diploma or equivalent; 1–2 years of utilization review preferred. Requires analytical, communication, collaboration, case management, authorization, behavioral health, and regulatory knowledge.
Microsoft Office 365, SmartSheets, Kipu, Collaborate MD, Sigmund Electronic Management system
2w
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RN Utilization Review Specialist | Case Management | Nights
Yuma, Arizona, United States
$44-$70/hr OnsiteFull Time
3+ YOEAssociate degree, Arizona RN license, BLS certification, and three years of related experience required. Requires clinical utilization review, medical necessity, payer communication, and regulatory compliance expertise.
CMS, Hospital Issued Notice of Non-Coverage (HINN), Advanced Beneficiary Notice (ABN), Medicare Outpatient Observation Notice (MOON), Important Message from Medicare (IMM), Condition Code 44 (CC44)
2w
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Registered Nurse Utilization Review Per Diem
Arizona, United States
RemotePart Time
1+ YOERequires RN state or compact licensure, ADN required and BSN preferred, 3 years of acute care RN experience, and 1 year of utilization review, utilization management, or case management experience.
DRG
1mo
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Supervisor, Utilization Management
Phoenix or Alaska or Arkansas or Arizona or Colorado or Florida or Hawaii or Iowa or Idaho or Illinois or Kansas or Louisiana or Maryland or Minnesota or Missouri or Montana or Nebraska or Nevada or New Mexico or North Carolina or North Dakota or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or District of Columbia or Washington or Wisconsin or Wyoming
$91k-$107k/yr RemoteFull Time
3+ YOE3+ MgmtCurrent RN license, 3+ years healthcare experience, 3+ years supervisory experience, 2+ years utilization review/case management, U.S. citizenship and favorable DoD background investigation required.
InterQual, ICD, DSM, CPT, HCPCS, American Dental codes, Microsoft Office, Microsoft Word, Microsoft Outlook, TriWest Intranet
1mo
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RN, Case Manager
Arizona or Tucson or Phoenix or Mesa or Maricopa County or Pinal County
$35-$59/hr RemoteFull Time
3+ YOEActive RN license in state worked, BLS required, 3+ years clinical experience (3-5 preferred), bachelor's degree in case management or health care, care management/utilization review knowledge; CCM preferred.
1mo
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Supervisor, Utilization Management
Phoenix or Alaska or Arkansas or Arizona or Colorado or Florida or Hawaii or Iowa or Idaho or Illinois or Kansas or Louisiana or Maryland or Minnesota or Missouri or Montana or Nebraska or Nevada or New Mexico or North Carolina or North Dakota or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or District of Columbia or Washington or Wisconsin or Wyoming
$91k-$107k/yr RemoteFull Time
3+ YOE3+ MgmtActive RN license, 3+ years healthcare experience, 3+ years supervisory experience, 2+ years utilization review/case management, U.S. citizenship and favorable DoD background investigation required; CCM/HCQM preferred.
Microsoft Office, Microsoft Word, Microsoft Outlook, InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Current Procedural Terminology, Healthcare Common Procedural Coding System
2d
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Specialist - Clinical Review
Phoenix, Arizona, United States
$74k-$109k/yr OnsiteFull Time
3+ YOERequires an associate degree or nursing diploma, valid RN licensure, 2+ years reviewing medical necessity denials, and 3+ years in healthcare revenue cycle, utilization review, case management, clinical appeals, or denial management.
practice management system, KPIs
6d
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RN Case Manager PRN
Payson or United States
OnsitePart Time
3+ YOEBachelor's degree in case management or health care, current RN license, BLS for acute care, and 3–5 years clinical experience with case management, utilization review, acute care, or home care knowledge.
1mo
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Nurse Case Manager, Sacred Peaks
Flagstaff, Arizona, United States
OnsiteFull Time
3+ YOEAssociate's or Bachelor's in Nursing, active professional nursing license, current BLS, 3 years clinical nursing experience with 1 year outpatient/inpatient, case management and utilization review knowledge.
1mo
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Case Manager-ED
Kingman, Arizona, United States
OnsiteFull Time
1+ YOERN in Arizona, BLS, 1+ year acute care experience (or 3 years sub-acute), knowledge of utilization review/MCG, discharge planning, strong communication and PC skills.
MCG
1mo
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Nurse Case Manager - Sign On Eligible
Tuba City, Arizona, United States
OnsiteFull Time
3+ YOEAssociate’s or Bachelor’s in Nursing, unrestricted professional nursing license, current BLS, 3+ years clinical nursing with 1 year outpatient/inpatient, knowledge of case management and utilization review.
2w
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Case Management Director
Glendale, Arizona, United States
OnsiteFull Time
3+ YOERequires 3 years of hospital-based case management experience, including utilization review and discharge planning. Active discipline license required where applicable; bachelor's degree required, BSN and RN license for nursing.
1w
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Medical Director
Arizona, United States
$226k-$429k/yr RemoteFull Time
Board-certified MD or DO with an unrestricted Arizona license, active medical practice, and expertise in medical management, utilization review, quality improvement, and complex case review.
4d
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Clinical Appeals Specialist II-Hybrid
Rochester or Phoenix or Scottsdale or Jacksonville
$88k-$124k/yr HybridFull Time
3+ YOEAssociate degree, 3 years of relevant nursing experience, and active unrestricted RN license required. Appeals, coding, utilization review, and case management experience preferred.
Milliman Care Guidelines, InterQual Criteria, Epic, Microsoft Office Suite, ICD-10-CM/PCS
2w
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Clinical Appeals Coordinator
Oregon or Kansas or Wisconsin or Arizona or South Dakota or North Dakota or Washington or Nevada or Montana or Idaho or New Mexico or Utah or Iowa or Wyoming or Colorado or Missouri or Texas or Minnesota
$34-$61/hr RemoteFull Time
4+ YOERN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years; applicable state license required. Managed care or utilization review experience preferred.
NCQA
2d
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Nurse Navigator
Phoenix, Arizona, United States
HybridFull Time
3+ YOEAssociate's degree in nursing, active RN license, and 3+ years of acute-care clinical experience required. Utilization management, case management, claims review, and BSN experience preferred.
3d
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Program Integrity Clinical Spc
Phoenix, Arizona, United States
$90k-$100k/yr RemoteFull Time
5+ YOERN or physician assistant with 5+ years varied clinical experience in managed care, 3 years utilization, quality, or case management experience, anti-fraud review experience, U.S. citizenship, and DoD background investigation eligibility.
Current Procedural Terminology, antifraud artificial intelligence software
2mo
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Clinical Document Integrity Specialist - Part Time - Remote (Mooresville, NC, US, 28117)
Mooresville or Alabama or Arizona or California or Colorado or Connecticut or Delaware or Florida or Georgia or Hawaii or Illinois or Indiana or Iowa or Kentucky or Louisiana or Maine or Maryland or Massachusetts or Michigan or Missouri or Montana or New Hampshire or New Jersey or New York or North Carolina or Ohio or Oregon or Pennsylvania or South Carolina or Tennessee or Texas or Virginia or Washington or District of Columbia
RemotePart Time
3+ YOEBSN/PA/NP/Doctorate in a medically related field required; 3+ years progressive acute care experience; prior case management/utilization review preferred; licensed as RN/PA/NP/MD preferred; CCDS/CCS/CDIP preferred; strong communication, critical thinking, and computer skills.
ICD-9, ICD-10, PCS, DRG, SOI/ROM, CDI database, AHIMA Practice Brief
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