Top 28 Clinical documentation & utilization review nurses Jobs in Phoenix, Az

Utilization Management Clinical Reviewer
TriWest Healthcare Alliance —Phoenix, AZ
- $88,000 - $93,000 a year
- Overtime
- Microsoft Excel
- Microsoft Outlook
- RN License
- AD&D insurance
- Disability insurance
Clinical Documentation Improvement Specialist - Hybrid- Phoenix
Optum —Phoenix, AZ
- $72,800 - $130,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Excel
- Hospital
7d
Clinical Documentation Integrity Specialist - Phoenix, AZ
Optum —Phoenix, AZ
- Full-time
- Nursing
- 5 years
- Bachelor of Science in Nursing
Quick Apply
10d
Utilization Review Specialist
Copper Springs East —Gilbert, AZ
- Overtime
- CPR Certification
- Adults
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
UR Utilization Review Coordinator
CMC Phoenix —Phoenix, AZ
- $34 - $36 an hour
- Full-time
- Hospital
- Computer literacy
- HIPAA
Quick Apply
8d
ABA Clinical Reviewer
TriWest Healthcare Alliance —Phoenix, AZ
- $79,000 - $93,000 a year
- Full-time
- Microsoft Outlook
- Customer service
- Computer literacy
- AD&D insurance
- Disability insurance
Utilization Review Coordinator
Axiom Care —Phoenix, AZ
- Full-time
- Mid-level
- Residential
- Microsoft Office
- AD&D insurance
- Paid holidays
Quick Apply
4d
MDS Resource Nurse
Bandera Healthcare —Phoenix, AZ
- $38 - $42 an hour
- Full-time
- Skilled nursing facility
- LVN
- RN License
- Health savings account
- Health insurance
Quick Apply
Clinical Quality Coordinator/Nurse (In-Person)
Uplift Hospice —Scottsdale, AZ
- From $87,500 a year
- Full-time
- Nursing
- Anatomy knowledge
- RN License
- Health insurance
- Dental insurance
Quick Apply
Quality of Care Investigative Nurse (RN)
MSR Health —Phoenix, AZ
- $32.48 an hour
- Contract
- Hybrid work
- Nursing
- RN License
- Research
Quick Apply
1d
MDS Nurse LPN / RN
Rio Vista Post Acute And Rehabilitation —Peoria, AZ
- $35 - $41 an hour
- Full-time
- Background check
- Skilled nursing facility
- LVN
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator (Part Time)
Osborn Health and Rehabilitation —Scottsdale, AZ
- $35 - $40 an hour
- Part-time
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
9d
Assistant MDS Coordinator - Nurse
Desert Terrace Healthcare Center —Phoenix, AZ
- $26 - $38 an hour
- Part-time
- In-person
- Leadership
- Entry level
- Health insurance
- Dental insurance
Quick Apply
15h
Clinical Documentation Improvement- MD or APP
Suvida Healthcare —Phoenix, AZ
- Full-time
- Medicine
- Mid-level
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
RN Case Manager - Utilization Review
The CORE Institute Specialty Hospital —Phoenix, AZ
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Health insurance
Quick Apply
RN Performance Improvement Coordinator
Hospice of the Valley —Phoenix, AZ
- Full-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Health insurance
10d
MARKET APPEALS SPECIALIST- CENTRAL APPEALS OFFICE
Behavioral Health Shared Services Group —Scottsdale, AZ
- Full-time
- Remote
- Microsoft Excel
- RN License
- Inventory management
- Health insurance
- Dental insurance
Clinical Services Coordinator
PHI Health, LLC —Tempe, AZ
- Full-time
- Mid-level
- Microsoft Office
- 3 years
Quick Apply
Quality Nurse – QAPI Coordinator
Innovative Health Care —Scottsdale, AZ
- $75,000 - $85,000 a year
- Full-time
- Nursing
- RN License
- Bachelor of Science
Quick Apply
MDS Coordinator - RN
HumanGood —Phoenix, AZ
- $47 - $58 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Health savings account
- Health insurance
Quick Apply
4d

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Utilization Management Clinical Reviewer

TriWest Healthcare Alliance -
Phoenix, AZ

Apply Now

Job Details

Full-time
$88,000 - $93,000 a year

Benefits

AD&D insurance
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
RN License
Computer literacy
Utilization management
Decision making
Resource utilization in healthcare
Microsoft Teams
Nursing

Full Job Description

Profile

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources. Applies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. Utilizes clinical criteria and policy keys to complete review. Documents in the medical management information system. Prepares and presents more complex cases for Medical Director Review. Refer cases to Case Management and Disease Management as appropriate. Advises non-clinical staff on clinical and coding questions. Conducts pre-admission screening and assessments.

Education & Experience

Required:

Active, unrestricted RN license
U.S. Citizen
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
2+ years clinical experience
2+ years UM experience
Proficient computer skills including Microsoft Office Suite (Teams, Word, Excel and outlook)
Demonstrates effective verbal and written communication skills

Preferred:

3+ years Medical / Surgical experience
Behavioral Health experience
1 year TriWest or TRICARE experience
Managed Care experience

Key Responsibilities

Conducts prior authorization, continued stay, and referral management activities.
Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines Policy Keys and Behavioral Health criteria.
Interprets information and makes decision whether authorizations align with the TriWest benefit program.
Ensures timely reviews for requesting facilities and appropriate notification to parties.
Contacts beneficiary and / or provider to obtain or clarify medical information as necessary.
Refers cases to Case Management, Care Coordination, or Disease Management for review as necessary.
Prepares cases for Medical Director and Peer Review according to established policy.
Refers potential quality issues and complaints to Clinical Quality Management.
Notifies Internal Audit & Corporate Compliance department of cases for review of potential fraud.
Maintain compliance with Federal, State and accreditation organizations.
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment

Technical Skills: Knowledge of TRICARE policies and procedures, Utilization Management principles, Managed Care concepts, medical terminology, medical management system, InterQual criteria, working knowledge of medical coding

Working Conditions

Working Conditions:

Ability to cover any work shift
Ability to work overtime, if needed
Onsite: Works within a standard office environment
Remote: Private and secure work space and work station with high speed internet is required.
Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $88,000 - $93,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Apply Now

Refine Your Search

clinical documentation & utilization review nurses jobs in phoenix, az

Utilization Management Clinical Reviewer

Clinical Documentation Improvement Specialist - Hybrid- Phoenix

Clinical Documentation Integrity Specialist - Phoenix, AZ

Utilization Review Specialist

UR Utilization Review Coordinator

ABA Clinical Reviewer

Utilization Review Coordinator

MDS Resource Nurse

Clinical Quality Coordinator/Nurse (In-Person)

Quality of Care Investigative Nurse (RN)

MDS Nurse LPN / RN

MDS Coordinator (Part Time)

Assistant MDS Coordinator - Nurse

Clinical Documentation Improvement- MD or APP

RN Case Manager - Utilization Review

RN Performance Improvement Coordinator

MARKET APPEALS SPECIALIST- CENTRAL APPEALS OFFICE

Clinical Services Coordinator

Quality Nurse – QAPI Coordinator

MDS Coordinator - RN

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