- CVS Health (Salt Lake City, UT)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... weeks on camera training required 100% participation during 8:30am-5pm Monday-Friday. * A Registered Nurse that must hold an unrestricted license in their state… more
- Intermountain Health (Salt Lake City, UT)
- …manage utilization through appropriate review of authorization requests. Scope As a Utilization Review RN you need to know how to: + Use nationally ... **Job Description:** Proactively manage inpatient and outpatient utilization to assure that medical care is appropriate,...recognized review criteria to ensure that patient status is at… more
- 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 ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Required** + Current license to practice as a Registered Nurse in the State of Utah,… more
- Molina Healthcare (Layton, UT)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who be licensed in the state they reside. We are looking for a RN Supervisor ... to cover rotating weekend shifts Preferred candidate with Utilization Management and leadership experience (Direct Reports) Compact RN license strongly… more
- CVS Health (Salt Lake City, UT)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- HCA Healthcare (Salt Lake City, UT)
- …+ Lead centralized case management function, including Clinical Case Management , Utilization Review Services, and Clinical Documentation Improvement. ... management experience required + Currently licensed as a Registered Nurse in the state(s) of practice...centralized case management function, including Clinical Case Management , Utilization Review Services, and… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Community Care (CC) Nurse is a licensed professional registered nurse assigned to coordinate care for Veterans requesting or referred for ... S/he has evidence of self-direction and application of Care Management and/or Utilization Management , with...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Molina Healthcare (Layton, UT)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing....Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… more
- Highmark Health (Salt Lake City, UT)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Molina Healthcare (Layton, UT)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Highmark Health (Salt Lake City, UT)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Molina Healthcare (Layton, UT)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- HCA Healthcare (Bountiful, UT)
- …you passionate about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside ... clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Mountain...career! We are interviewing candidates for our Operating Room Registered Nurse opening. **Apply today and a… more
- CVS Health (Salt Lake City, UT)
- …Assessment of members through the use of clinical tools and information/data review , conducts comprehensive evaluation of member's needs and benefit plan eligibility ... Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits… more
- Molina Healthcare (Layton, UT)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… 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 ... coordination of care activities under the direction of a registered nurse and/or social worker. + The...discharge plans prepared and delegated by social work or nurse case management by coordinating with home… 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 ... Specific Overview:** * Collaborate with inpatient Nephrology and Case Management teams to secure dialysis setup and resumption of...the following** + Current license to practice as a Registered Nurse in the State of Utah,… more
- Sedgwick (Salt Lake City, UT)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple ... business lines; and to provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the… more
- Intermountain Health (Salt Lake City, UT)
- …medical records from the Health Information Management for retrospective utilization or quality assurance review . + Delivers routine regulatory notices ... authorization of services based on contractual requirements. + Promptly communicates utilization review needs, days authorized, denials, and other communication… more
- Sharecare (Salt Lake City, UT)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more