Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success.* Supports patient to ensure appropriate compliance ...
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success.* Supports patient to ensure appropriate compliance ...
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
RN Care Manager - Cottonwood, AZ
Cottonwood, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Quick apply
RN Care Manager - Cottonwood, AZ
Cottonwood, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
RN Care Manager - Cottonwood, AZ
Cottonwood, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Quick apply
RN Care Manager - Cottonwood, AZ
Cottonwood, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Utilization Review Manager
Phoenix, AZ · On-site
For over 60 years, Calvary Healing Center has provided a full continuum of care, specializing in ... The UR Manager oversees utilization management including, but not limited to: utilization review ...
Utilization Review Manager
Phoenix, AZ · On-site
For over 60 years, Calvary Healing Center has provided a full continuum of care, specializing in ... The UR Manager oversees utilization management including, but not limited to: utilization review ...
Utilization Review Manager
Phoenix, AZ · On-site
For over 60 years, Calvary Healing Center has provided a full continuum of care, specializing in ... The UR Manager oversees utilization management including, but not limited to: utilization review ...
Utilization Review Manager
Phoenix, AZ · On-site
For over 60 years, Calvary Healing Center has provided a full continuum of care, specializing in ... The UR Manager oversees utilization management including, but not limited to: utilization review ...
RN Care Manager - Cottonwood, AZ - relocation to COTTONWOOD, Arizona
Phoenix, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
Quick apply
RN Care Manager - Cottonwood, AZ - relocation to COTTONWOOD, Arizona
Phoenix, AZ · On-site
$34.16 - $51.25/hr
Utilization Management * Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success. * Supports patient to ensure appropriate compliance ...
RN Utilization Management Care Reviewer
Phoenix, AZ · Remote
$37.14 - $61.90/hr
Utilization Mgmt Work Shift: Day Job Category: Clinical Care Nursing careers are better at Banner Health. We've built smarter processes to help nurses focus on what really matters. If you want to ...
RN Utilization Management Care Reviewer
Phoenix, AZ · Remote
$37.14 - $61.90/hr
Utilization Mgmt Work Shift: Day Job Category: Clinical Care Nursing careers are better at Banner Health. We've built smarter processes to help nurses focus on what really matters. If you want to ...
Demonstrates knowledge of home care processes and all specialty programs in all communications with ... Manager. * Must have excellent verbal and written communications and excellent customer service ...
Demonstrates knowledge of home care processes and all specialty programs in all communications with ... Manager. * Must have excellent verbal and written communications and excellent customer service ...
$40.45 - $62.70/hr
Previous experience in Utilization Management, Managed Care or chronic disease management highly preferred. Experience with Electronic Medical Record (EMR) platform preferred. Knowledge of InterQual ...
$40.45 - $62.70/hr
Previous experience in Utilization Management, Managed Care or chronic disease management highly preferred. Experience with Electronic Medical Record (EMR) platform preferred. Knowledge of InterQual ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Provide ongoing updates and notifications in the Sigmund Electronic Management system. Education ...
None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ... Provide ongoing updates and notifications in the Sigmund Electronic Management system. Education ...
Description The UR Coordinator's primary responsibility is managing, reviewing, and monitoring ... None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ...
Description The UR Coordinator's primary responsibility is managing, reviewing, and monitoring ... None. Who is Axiom Care? Founded in 2012, Axiom Care is a Phoenix-based behavioral health ...
Utilization Review
Tuba City, AZ · On-site
Rn - Utilization Review Cure Healthcare is seeking a RN - Utilization Review for positions in Tuba City, Arizona. Current Arizona license and AHA BLS and ACLS required and additional certifications ...
Utilization Review
Tuba City, AZ · On-site
Rn - Utilization Review Cure Healthcare is seeking a RN - Utilization Review for positions in Tuba City, Arizona. Current Arizona license and AHA BLS and ACLS required and additional certifications ...
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 ...
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 ...
Utilization Management Reviewer Requisition Number: R-000002878 Department Name: Supervisor ... Provides collaboration with multidisciplinary teams to support patient care coordination, discharge ...
Utilization Management Reviewer Requisition Number: R-000002878 Department Name: Supervisor ... Provides collaboration with multidisciplinary teams to support patient care coordination, discharge ...
RN Utilization Review
Tuba City, AZ · On-site
... the care team on discharge planning and transitions, manage resource use to control costs ... utilization review processes. Demonstrate knowledge of electronic health record systems.
RN Utilization Review
Tuba City, AZ · On-site
... the care team on discharge planning and transitions, manage resource use to control costs ... utilization review processes. Demonstrate knowledge of electronic health record systems.
Utilization Review Nurse
Tempe, AZ · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Quick apply
Utilization Review Nurse
Tempe, AZ · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Travel Utilization Review RN - $2,772 per week
Tuba City, AZ · On-site
$2.7K/wk
Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...
Travel Utilization Review RN - $2,772 per week
Tuba City, AZ · On-site
$2.7K/wk
Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...
This is primary for case management functions but can assist with utilization management if a ... Within 4 years of hire as a Care Manager employee must hold a certification in case management from ...
This is primary for case management functions but can assist with utilization management if a ... Within 4 years of hire as a Care Manager employee must hold a certification in case management from ...
Utilization Care Manager information
What is a utilization care manager?
Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.
How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?
Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.
What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?
To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.
What is the difference between Utilization Care Manager vs Utilization Review Nurse?
| Aspect | Utilization Care Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, case management certification | RN, certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies | Hospitals, insurance companies, outpatient clinics |
| Primary Focus | Coordinating patient care, managing resources | Reviewing medical necessity, approving treatments |
Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.
What does a utilization care manager do in healthcare?
A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.
What are popular job titles related to Utilization Care Manager jobs in Arizona?
For Utilization Care Manager jobs in Arizona, the most frequently searched job titles are:
- Remote Utilization Management Nurse
- Independent Contractor Remote Utilization Management Nurse
- Full Time Cvs Health Utilization Management
- Registered Nurse Utilization Review
- Evening Optum Health Utilization Review
- Insurance Review Nurse
- Per Diem Utilization Review Nurse
- Per Diem Remote Chart Review Nurse
- Manager Utilization Management
- Work From Home Oasis Review Nurse
What job categories do people searching Utilization Care Manager jobs in Arizona look for?
The top searched job categories for Utilization Care Manager jobs in Arizona are:
Other
Re-posted 13 hours ago
Northern Arizona Healthcare rating
8.0
Based on 59 frontline employees who took The Breakroom Quiz
86th of 891 rated healthcare providers
Job description
Overview
The RN Care Manager is responsible a Registered Nurse with years of diverse nursing experience and success in managing complex situations. The RN is an expert in clinical nursing knowledge for specific populations and chronic diseases. This position requires both internal and external interface with providing care management to populations the connect with health insurance attributed lists, emergency rooms, hospitals, primary care services. The care manager functions across the care continuum, interfacing with the multi-disciplinary team to facilitate the best possible clinical outcomes and optimal level of wellness with the most appropriate resource. This role is essential to the success of meeting high risk patient's needs post- discharge and preventing unnecessary readmissions. The care manager will collaborate with the interdisciplinary team to identify, assess, plan, implement, coordinate, monitor, and evaluate options and services in meeting the needs of high risk individuals and their complex medical needs.
Responsibilities
Patient Care
* Evaluate attributed patients identified to provide clinical care management risk attribution.
* Complete psychosocial assessments and develop care plans with identified patient to lower risk threshold for care delivery.
Care Coordination
* Develop a relationship with primary care, specialty services, emergency and hospital networks required for inter-disciplinary care management.
* Facilitates the progression of care by advancing the care plan identification of outcomes, implementation plan and sets goals that are measurable, realistic, and individualized.
* Utilizes hospital, community and national resources to maintain and enhance knowledge and expertise of the care management team.
* Identifies highest quality, most effective post discharge providers and builds relationship to provide highest quality, lowest cost care at the right stage of patients recovery.
Utilization Management
* Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success.
* Supports patient to ensure appropriate compliance and support occurs to avoid readmission or poor quality outcomes.
* Monitors outcomes and develops process change to improve care.
Data Integrity
* Respects and upholds patient rights, demonstrates professional integrity, maintains patient confidentiality, discloses all potential or perceived conflicts of interest when appropriate; accepts responsibility and accountability for professional competence.
* Ensures appropriate documentation in the electronic medical record.
Compliance/Safety
* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
* If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
* Completes all company mandatory modules and required job specific training in the specified time frame.
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
Qualifications
Education
The RN Care Manager is responsible a Registered Nurse with years of diverse nursing experience and success in managing complex situations. The RN is an expert in clinical nursing knowledge for specific populations and chronic diseases. This position requires both internal and external interface with providing care management to populations the connect with health insurance attributed lists, emergency rooms, hospitals, primary care services. The care manager functions across the care continuum, interfacing with the multi-disciplinary team to facilitate the best possible clinical outcomes and optimal level of wellness with the most appropriate resource. This role is essential to the success of meeting high risk patient's needs post- discharge and preventing unnecessary readmissions. The care manager will collaborate with the interdisciplinary team to identify, assess, plan, implement, coordinate, monitor, and evaluate options and services in meeting the needs of high risk individuals and their complex medical needs.
Responsibilities
Patient Care
* Evaluate attributed patients identified to provide clinical care management risk attribution.
* Complete psychosocial assessments and develop care plans with identified patient to lower risk threshold for care delivery.
Care Coordination
* Develop a relationship with primary care, specialty services, emergency and hospital networks required for inter-disciplinary care management.
* Facilitates the progression of care by advancing the care plan identification of outcomes, implementation plan and sets goals that are measurable, realistic, and individualized.
* Utilizes hospital, community and national resources to maintain and enhance knowledge and expertise of the care management team.
* Identifies highest quality, most effective post discharge providers and builds relationship to provide highest quality, lowest cost care at the right stage of patients recovery.
Utilization Management
* Ability to utilize care delivery techniques such as teach back and motivational interviewing to support patient success.
* Supports patient to ensure appropriate compliance and support occurs to avoid readmission or poor quality outcomes.
* Monitors outcomes and develops process change to improve care.
Data Integrity
* Respects and upholds patient rights, demonstrates professional integrity, maintains patient confidentiality, discloses all potential or perceived conflicts of interest when appropriate; accepts responsibility and accountability for professional competence.
* Ensures appropriate documentation in the electronic medical record.
Compliance/Safety
* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
* If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
* Completes all company mandatory modules and required job specific training in the specified time frame.
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
Qualifications
Education
- Bachelor's Degree in Nursing- Required if hired after December 2018
- Master's Degree in Nursing- Preferred
- Current, unrestricted license in the State of Arizona- Required
- BLS (American Heart Assoc.)- Required
- Fingerprint Clearance Card application number- Required upon hire
- Fingerprint Clearance Card- Required within 90 days of hire
- Two years as a Registered Nurse- Required
- Care Management or Nurse Navigator experience- Preferred
What Northern Arizona Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Northern Arizona Healthcare
Sourced by ZipRecruiter
Northern Arizona Healthcare (NAH) is a preeminent health service provider headquartered in Flagstaff, Arizona, US. Founded on an unwavering commitment to deliver compassionate, world-class care, NAH is a key player in the healthcare industry. The key services include cardiology, oncology, emergency services, surgery, women's health services, among others. With operations established over a century ago, it started serving the community in Flagstaff since 1911 before expanding to other locations. NAH's mission lodges the cornerstone that every individual should have access to top-quality, cost-effective health care. NAH's achievements range from national recognitions in patient safety to infrastructure development, like the opening of the new Children’s Health Center, highlighting their commitment to toddler health.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Flagstaff, AZ, US
Year founded
1936