Top 467 Utilization management Jobs in Phoenix, Az

Medical Case Manager
AmTrust Financial Services, Inc. —Scottsdale, AZ
- $80,000 - $91,000 a year
- Full-time
- Hybrid work
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Clinic Director - ABA Services
MeBe —Mesa, AZ
- $99,000 - $200,000 a year
- Full-time
- Applied behavior analysis
- Clinic
- Children
- Continuing education credits
- AD&D insurance
Quick Apply
Center Operations Director
Soar Autism Center —Mesa, AZ
- $80,000 - $100,000 a year
- Clinic
- Bachelor's degree
- Children
- Loan repayment program
- Health insurance
Quick Apply
6d
Utilization Management Coordinator - PRN
Quail Run Behavioral Health —Phoenix, AZ
- PRN
- Mid-level
- Master's degree
- Bachelor's degree
- Health insurance
- Dental insurance
8d
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
14d
BH UM Clinical Reviewer- Remote AZ
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Mid-level
- Organizational skills
- 1 year
Medical Office Manager
Arizona Colorectal Experts —Chandler, AZ
- $75,000 - $100,000 a year
- Full-time
- Background check
- Surgery
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Vice President, Operations - Remote
Tia —Scottsdale, AZ
- $250,000 - $300,000 a year
- SQL
- Clinic
- Ob/Gyn
- Travel reimbursement
- Health insurance
Quick Apply
Supervisor, Utilization Review (TOC) - Hybrid
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Microsoft Word
- Nursing
- RN License
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
9d
Supervisor, Utilization Management
TriWest Healthcare Alliance —Phoenix, AZ
- $101,000 - $107,000 a year
- Full-time
- Nursing
- Microsoft Outlook
- RN License
- AD&D insurance
- Disability insurance
Care Management Healthcare Consultant
State of Arizona —Phoenix, AZ
- From $71,032 a year
- Full-time
- Hybrid work
- Background check
- RN License
- Research
- Paid parental leave
- Paid holidays
3d
Claims Clinical Documentation Reviewer
State of Arizona —Phoenix, AZ
- $68,000 - $71,032 a year
- Full-time
- Background check
- Writing skills
- Research
- Paid parental leave
- Paid holidays
Prior Authorization Representative I
Arizona Priority Care —Chandler, AZ
- $20 - $23 an hour
- Full-time
- Hybrid work
- Office
- Administrative experience
- High school diploma or GED
Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] – Behavioral Health
Sanctuary Recovery Centers —Phoenix, AZ
- $24 - $29 an hour
- Full-time
- HIPAA
- Mid-level
- Office
Quick Apply
13h
Assistant Healthcare Services Director
Blue Stone Strategy Partners —Phoenix, AZ
- $127,007 - $158,759 a year
- Weekends as needed
- Mid-level
- Master's degree
- Analysis skills
Quick Apply
Clinical Quality Management Coordinator
State of Arizona —Phoenix, AZ
- From $71,032 a year
- Full-time
- Hybrid work
- Background check
- RN License
- Research
- Paid parental leave
- Paid holidays
Placement Liaison
Banner Health —Glendale, AZ
- Full-time
- Hospital
- Medical office experience
- Mid-level
- Health insurance
2d
Director, Care Management & Social Work
Phoenix Children's Hospital —Phoenix, AZ
- Full-time
- Inpatient
- Children
- Pediatrics
6d
Case Manager Care Coordination
Banner Health —Sun City, AZ
- Full-time
- Acute care
- Master of Social Work
- Nursing
1d

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Medical Case Manager

AmTrust Financial Services, Inc. -
Scottsdale, AZ

Apply Now

Job Details

Full-time
$80,000 - $91,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Opportunities for advancement
Life insurance

Qualifications

RN License

Full Job Description

Overview:

AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.

PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.

This position is hybrid out of Irvine, CA, Scottsdale, AZ or Salt Lake City, UT.

Responsibilities:

Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary
Responsible for accurate comprehensive documentation of case management activities in case management system.
Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.
Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.
Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
May assist in training/orientation of new staff as requested
Other duties may be assigned.
Supports the organization's quality program(s).

Qualifications:

Education & Licensing

Active unrestricted RN license in Arizona or Utah. California is preferred.
Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
Ability to acquire, and maintain, appropriate Professional Certifications and Licenses to comply with respective state laws may be required
Preferred for license(s) to be obtained within three - six months of starting the job.
Written and verbal fluency in Spanish and English preferred

Experience

Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required.

Skills & Knowledge:

Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
Knowledge of behavioral health
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytic and interpretive skills
Strong organizational skills
Excellent interpersonal and negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking

The expected salary range for this role is $80,000.00-$91,000.00.

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.

What We Offer:

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Apply Now

Refine Your Search

utilization management jobs in phoenix, az

Medical Case Manager

Clinic Director - ABA Services

Center Operations Director

Utilization Management Coordinator - PRN

Utilization Management Clinical Reviewer

BH UM Clinical Reviewer- Remote AZ

Medical Office Manager

Vice President, Operations - Remote

Supervisor, Utilization Review (TOC) - Hybrid

MARKET APPEALS SPECIALIST- CENTRAL APPEALS OFFICE

Supervisor, Utilization Management

Care Management Healthcare Consultant

Claims Clinical Documentation Reviewer

Prior Authorization Representative I

Utilization Review (UR) Coordinator / Authorization Representative [Clinical Experience Preferred] – Behavioral Health

Assistant Healthcare Services Director

Clinical Quality Management Coordinator

Placement Liaison

Director, Care Management & Social Work

Case Manager Care Coordination

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