- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... Current license to practice as a Registered Nurse in the State of Utah, or obtain one...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Molina Healthcare (West Valley City, UT)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... For this position we are seeking a (RN) Registered Nurse who be licensed in the state they reside....are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office… more
- Molina Healthcare (Orem, UT)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... **Required Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical … more
- Evolent (Salt Lake City, UT)
- …Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Salt Lake City, UT)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- University of Utah (Salt Lake City, UT)
- …**Open Date** 04/03/2025 **Requisition Number** PRN41558B **Job Title** PS Clinical Nurse Specialist **Working Title** Clinical Research Nurse **Job Grade** ... Rate Range** 47600 to 74609 **Close Date** 07/02/2025 **Priority Review Date (Note - Posting may close at any...roles in the area of clinical expertise. The Clinical Nurse Specialist makes decisions independently and in collaboration with… more
- Molina Healthcare (UT)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Provo, UT)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Sharecare (Salt Lake City, UT)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- Intermountain Health (Saratoga Springs, UT)
- …accredited institution. Degree will be verified. + Experience in case management, utilization review , or discharge planning. **Physical Requirements:** + Ongoing ... **Job Description:** The Nurse Care Manager works collaboratively with physicians and...team + Personalized Primary Care: + Completes pre-visit planning ( review chart before visit, notify patient of tests needed… more
- CVS Health (Salt Lake City, UT)
- …unrestricted state licensure required in state of residence **Preferred Qualifications** Utilization Management review Managed Care experience Client processing ... each and every day. **Position Summary** Responsible for the review and evaluation of clinical information and documentation. Reviews...experience **Education** Registered Nurse **Anticipated Weekly Hours** 40 **Time Type** Full time… more
- Lincoln Financial (Salt Lake City, UT)
- …Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like to work here?** At ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Evolent (Salt Lake City, UT)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Intermountain Health (Murray, UT)
- …verified. + Case management Certification. + Experience in Case management, Utilization review , and/or discharge planning. **Physical Requirements:** + Ongoing ... **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical...+ Current RN license for state in which the nurse practices. + Three years of clinical nursing experience.… more
- Highmark Health (Salt Lake City, UT)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (Orem, UT)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Molina Healthcare (Provo, UT)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Molina Healthcare (Provo, UT)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health Care ... coordination of care activities under the direction of a registered nurse and/or social worker. The incumbent interacts with representatives from insurance… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- …(PACT) or the clinical team within the Specialty they are supporting, to review clinic appointment availability ( utilization ) to ensure that clinic schedules are ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules… more