- Molina Healthcare (West Valley City, UT)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… 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
- Highmark Health (Salt Lake City, UT)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… 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 ... coordination of care activities under the direction of a registered nurse and/or social worker. The incumbent...discharge plans prepared and delegated by social work or nurse case management by coordinating with home… more
- Molina Healthcare (West Valley City, 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
- 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...the following** + Current license to practice as a Registered Nurse in the State of Utah,… more
- HCA Healthcare (Salt Lake City, UT)
- …advance the agenda of unparalleled patient service. **What qualifications you will need:** + Registered Nurse + BSN preferred + 5 years of nursing experience ... stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in...personal growth, we encourage you to apply for our RN Case Manager PRN opening. We review … more
- Molina Healthcare (West Valley City, UT)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes… more
- Guardian Life (Salt Lake City, UT)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Intermountain Health (Murray, UT)
- …medical records from the Health Information Management for retrospective utilization or quality assurance review . + Delivers routine regulatory notices ... authorization of services based on contractual requirements. + Promptly communicates utilization review needs, days authorized, denials, and other communication… more
- University of Utah Health (Salt Lake City, UT)
- …from either an IT/Systems Analyst role, or from a Clinical science role (ie RN , PA level clinical roles).** **Hybrid position, so need to be local or willing ... as a resource to end users and team members with regard to application utilization in context with workflow. + Performs the execution and update of test scripts,… more