- 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
- CenterWell (Salt Lake City, UT)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… 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
- 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 ... trust that are integral to our mission. EO/AA_ + The Staff Utilization Coordinator is responsible for providing healthcare operational support services, including… more
- Molina Healthcare (Salt Lake City, UT)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… 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 ... Rate Range** 47600 to 74609.60 **Close Date** 02/17/2026 **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
- Intermountain Health (Murray, UT)
- …needs in area(s) of responsibility. Completes documentation as required. Performs utilization review activities to provide patient appropriate, timely, and ... **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical...management Certification. - and - Experience in Case management, Utilization review , and/or discharge planning. **Physical Requirements:**… 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 (Draper, UT)
- …from any other healthcare provider. We are seeking an Operating Room Registered Nurse to join our healthcare family. **Benefits** Lone Peak Surgery Center, offers a ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Bountiful, UT)
- …have the opportunity to make a real impact. As an Operating Room Registered Nurse you can be a part of change. **Benefits** Mountain West Surgery Center, offers ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Salt Lake City, UT)
- …important to you, we encourage you to apply for our Operating Room Registered Nurse opening. Our team will promptly review your application. Highly qualified ... positions. Join our Team as an Operating Room Registered Nurse and access programs to assist with every stage...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… 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
- CVS Health (Salt Lake City, UT)
- …As a QM Nurse Consultant you will be responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets ... required - 2+ years of experience as a Registered Nurse - Must have active, current and unrestricted RN...5:00pm in time zone of residence **Preferred Qualifications** - Utilization Management review - Managed Care experience… 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. ... Summary and Qualifications** We are seeking an Operating Room Nurse for our ambulatory surgery center who demonstrates the...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Molina Healthcare (Salt Lake City, UT)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Salt Lake City, 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 (Salt Lake City, UT)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Molina Healthcare (Salt Lake City, 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
- Highmark Health (Salt Lake City, UT)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… 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