- University of Utah Health (Salt Lake City, UT)
- …and 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
- Humana (Salt Lake City, UT)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Molina Healthcare (Orem, UT)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- University of Utah (Salt Lake City, UT)
- …**Open Date** 01/07/2026 **Requisition Number** PRN43960B **Job Title** PS Clinical Nurse Specialist **Working Title** Clinical Research Nurse **Career ... Rate Range** 47600 to 90400 **Close Date** 03/31/2026 **Priority Review Date (Note - Posting may close at any...on current clinical and research information. 8. Collaborates with Nurse Manager in orientation of new employees and provides… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Advanced Practice Nurse (APN) Certified Nurse Anesthetist (CNA) is a Certified Registered Nurse Anesthetist (CRNA). The CRNA provides a full ... Respect, and Excellence VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for… more
- CVS Health (Salt Lake City, UT)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… 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
- Evolent (Salt Lake City, UT)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- HCA Healthcare (West Valley City, UT)
- …satisfaction and personal growth, we encourage you to apply for our OR Registered Nurse PRN opening. We review all applications. Qualified candidates will be ... have the PRN career opportunities as an OR Registered Nurse PRN you want with your current employer? We...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… 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
- Molina Healthcare (Orem, UT)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Orem, UT)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Orem, UT)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… 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
- Highmark Health (Salt Lake City, UT)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- HCA Healthcare (Salt Lake City, UT)
- …of ED and Throughput departments 2. Assess skill mix opportunities, agency nurse usage, and staffing 3. Identifies facility wide staffing and process opportunities ... ED and facility throughput 4. Supply, medication, and resource utilization 5. Appropriate assignment of patients being admitted to...and analysis of variances. + Perform data mining and review of financial and clinical data to assess operational… more
- University of Utah (Salt Lake City, UT)
- …( CPC , ACS , CCS -P/H, RHIA , or RHIT ). Preferences Knowledge of utilization review and quality assurance procedures as well as experience with InterQual or ... capacity OR current licensure to practice as a Registered Nurse ( BSN or APRN ) in the State...beliefs that object to vaccinations. **Preferences** 1. Knowledge of utilization review and quality assurance procedures, as… 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
- University of Utah Health (Salt Lake City, UT)
- …+ Negotiates with third party payers relative to benefit levels, eligibility, utilization review , and reimbursement. + Identifies actual and potential delays ... **Licenses Required** + **One of the following** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under… more
- Deloitte (Salt Lake City, UT)
- …nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health ... in nursing, medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical Documentation Specialist - CCDS… more