• Utilization Review Nurse

    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
    University of Utah Health (05/03/25)
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  • Clinical Reviewer, Nurse (Pain Mngt)

    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 (05/16/25)
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  • Appeals Licensed Practical Nurse

    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
    Evolent (05/16/25)
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  • Clinical Research Nurse

    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
    University of Utah (04/03/25)
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  • Registered Nurse , Case Manager - Oncology…

    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 - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
    CVS Health (05/16/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Layton, 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
    Molina Healthcare (05/16/25)
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  • Clinical Registered Nurse - Remote

    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
    Sharecare (05/10/25)
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  • Nurse Care Manager

    Intermountain Health (Murray, 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
    Intermountain Health (05/16/25)
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  • Consultant, Nurse Disability

    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
    Lincoln Financial (04/30/25)
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  • Hospital at Home Tele Registered Nurse

    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
    Intermountain Health (05/09/25)
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  • Appeals Nurse

    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
    Evolent (05/10/25)
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  • Transplant Care Nurse RN - Stem Cell, Bone…

    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
    Highmark Health (04/25/25)
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  • Care Review Clinician, PA (RN) - Transplant…

    Molina Healthcare (Layton, 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 (03/07/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Layton, 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 (05/02/25)
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  • Medical Director Specialty Medical Services…

    Molina Healthcare (Layton, 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 (04/09/25)
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  • Medical Support Assistant (Adv

    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
    Veterans Affairs, Veterans Health Administration (03/28/25)
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  • RN Case Manager

    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 ... 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
    University of Utah Health (05/09/25)
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  • Clinical Letter Writer - UM & Specialty Experience…

    Evolent (Salt Lake City, UT)
    …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... + Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of three… more
    Evolent (04/25/25)
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