- Humana (Salt Lake City, UT)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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
- Intermountain Health (Ogden, UT)
- …be 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...area(s) of responsibility. Completes documentation as required. + Performs utilization review activities to provide patient appropriate,… more
- HCA Healthcare (Salt Lake City, 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. ... clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Mt....Summary and Qualifications** We are seeking an Operating Room Nurse for our ambulatory surgery center who demonstrates the… more
- Fresenius Medical Center (Salt Lake City, UT)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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 ... discharge plans prepared and delegated by social work or nurse case management by coordinating with home...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Molina Healthcare (Layton, 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
- Evolent (Salt Lake City, UT)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… 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 ... behind it. **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
- Intermountain Health (Salt Lake City, UT)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… 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 ... **Overview** **Come join our growing Case Management Team! Utilize your clinical & critical thinking...following** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Molina Healthcare (Layton, UT)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- HCA Healthcare (Salt Lake City, UT)
- …the patient stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in collaboration with the ... supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +...patient service. **What qualifications you will need:** + Registered Nurse + BSN preferred + 5 years of nursing… more