- Molina Healthcare (Clearfield, UT)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Molina Healthcare (Clearfield, UT)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... 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… more
- Molina Healthcare (Clearfield, UT)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice.… more
- Humana (Salt Lake City, UT)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Utilization Management (UM) Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative ... standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Master's prepared Registered Nurse . 5 years Utilization Management … more
- CenterWell (Salt Lake City, UT)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Salt Lake City, UT)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Salt Lake City, UT)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… 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 ... 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… more
- University of Utah Health (Salt Lake City, UT)
- …Supervisor to reassign staff based on census and workload, adhering to the Nurse Utilization Policy. + Assist Hospital Supervisor and Nursing Leadership in ... are integral to our mission. EO/AA_ + The Staff Utilization Coordinator is responsible for providing healthcare operational support...care needs. + The role also involves proactive daily management to secure staff for open shifts to ensure… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The Patient Safety Manager-Registered Nurse (RN) executes position responsibilities that demonstrate leadership, experience, and creative approaches to ... management of complex patient care. The Patient Safety Manager...Executive Leadership in a format that is conducive for utilization in decision making, strategic planning and performance improvement.… more
- Molina Healthcare (Layton, UT)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- University of Utah (Salt Lake City, UT)
- …**Open Date** 11/19/2025 **Requisition Number** PRN43626B **Job Title** PS Clinical Nurse Specialist **Working Title** PS Clinical Research Nurse **Career ... care planning based on current clinical and research information. 8. Collaborates with Nurse Manager in orientation of new employees and provides feedback related to… more
- Molina Healthcare (Layton, UT)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… 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 ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Molina Healthcare (Salt Lake City, UT)
- …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… more
- HCA Healthcare (Bountiful, UT)
- …about delivering patient-centered care?** Submit your application for Operating Room Registered Nurse position and spend more time at the bedside with the patient. ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Mountain West Surgery Center!… more
- Evolent (Salt Lake City, UT)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… more
- University of Utah Health (Salt Lake City, UT)
- …solutions. + Conducts workflow analysis and makes recommendations for change management strategies. + Conducts quality assurance testing prior to solution deployment ... clinicians during training, go-live and after go-live to ensure utilization of the solution is correct. + Collaborates with...Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- University of Utah Health (Salt Lake City, UT)
- …+ Implements patient discharge plans prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care ... of care activities under the direction of a registered nurse and/or social worker. The incumbent interacts with representatives...related field. + One year of experience in a utilization review or case management environment. +… more
