- Humana (Salt Lake City, UT)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Salt Lake City, UT)
- …or 9:00am to 6:00pm in time zone of residence with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include ... holidays, and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + Experience… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** +… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our hospital ... you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic computer skills… more
- Humana (Salt Lake City, UT)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Salt Lake City, UT)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… 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** ... and administrative roles in the area of clinical expertise. The Clinical Nurse Specialist makes decisions independently and in collaboration with the hospital staff… more
- Evolent (Salt Lake City, UT)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Molina Healthcare (Salt Lake City, UT)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Sharecare (Salt Lake City, UT)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Intermountain Health (Provo, UT)
- …verified. + Case management Certification. + Experience in Case management , Utilization review, and/or discharge planning. **Physical Requirements:** + ... **Job Description:** The Nurse Care Manager utilizes clinical expertise and critical...area(s) of responsibility. Completes documentation as required. + Performs utilization review activities to provide patient appropriate, timely, and… more
- Highmark Health (Salt Lake City, UT)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Salt Lake City, UT)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Intermountain Health (Murray, UT)
- …verified. + Case management Certification. + Experience in Case management , Utilization review, and/or discharge planning. **Physical Requirements:** + ... **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 (Murray, UT)
- …Case management Certification. - and - Experience in Case management , Utilization review, and/or discharge planning. **Physical Requirements:** Ongoing need ... **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical...Qualifications Current RN license for state in which the nurse practices. - and - Three years of clinical… more
- United Therapeutics (Salt Lake City, UT)
- …for which transplant is not currently an option. Who you are You are experienced nurse and an expert in all things PAH. You love providing mentorship, coaching and ... make a difference. The Regional Field Director, RNS Program Management serves as a director of all clinical field...+ Plan, collaborate, create and produce the yearly Clinical Nurse Summit meeting for HCPS across the United States… more
- Molina Healthcare (Salt Lake City, UT)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Humana (Salt Lake City, UT)
- …**Key Functions:** **Strategic Planning and Implementation:** + Develop and implement utilization management strategies that align with organizational goals. + ... care. **Cost Containment:** + Identify opportunities for cost savings through effective utilization management practices. + Monitor and analyze utilization … more
- University of Utah Health (Salt Lake City, UT)
- …degree preferred) **Qualifications (Preferred)** **Preferred** + Licensure as a registered nurse strongly preferred + Management experience + Experience ... for cost savings related to product standardization and improved product utilization by appropriately assisting in the selection, evaluation, monitoring, analysis… more
- University of Utah Health (Salt Lake City, UT)
- …**Department Specific Overview:** * Collaborate with inpatient Nephrology and Case Management teams to secure dialysis setup and resumption of services within ... labs, imaging, and catheter removal * Maintain accurate and up-to-date Case Management documentation * Clear and accurate communication with inpatient and outpatient… more