- 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
- 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
- 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 (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
- Intermountain Health (Salt Lake City, UT)
- …+ Care Management Certification + Demonstrated experience in case management, utilization review , or discharge planning. **Physical Requirements** + Ongoing ... patients for proactive interventions using specific screening criteria, medical record review , payor models, medical risk scores, or referrals. Assesses patients'… 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 (Layton, 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 (Layton, 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 (Layton, 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
- 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
- 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
- Highmark Health (Salt Lake City, UT)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- HCA Healthcare (Salt Lake City, UT)
- …of ED and Throughput departments 2. Assess skill mix opportunities, agency nurse usage, and staffing 3. Identifies facility wide staffing and process opportunities ... ED and facility throughput 4. Supply, medication, and resource utilization 5. Appropriate assignment of patients being admitted to...and analysis of variances. + Perform data mining and review of financial and clinical data to assess operational… more
- 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
- Intermountain Health (Ogden, UT)
- …authorizations in accordance with contractual requirements and communicates with care managers, utilization review RNs, revenue cycle, and payers as needed to ... and retrieves medical records from Health Information Management for retrospective utilization review or quality assurance. + Delivers routine regulatory… more