- Cognizant (Salt Lake City, UT)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- Humana (Salt Lake City, UT)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… 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 ... to UR committee any case that surpasses expected LOS, expected cost, or over/under- utilization of resources. + Performs verbal/fax clinical review with payer as… more
- Molina Healthcare (West Valley City, UT)
- …hearing officer during fair hearings as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 11/19/2025 **Requisition Number** PRN43626B **Job Title** PS Clinical Nurse Specialist **Working Title** PS Clinical Research Nurse ... responsibilities and qualifications required of employees assigned to the job. The Clinical Nurse Specialist makes decisions independently and in collaboration… more
- Evolent (Salt Lake City, UT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- …extent of their education, training, & certification.. The CRNA provides advanced clinical practice, consultation, and management . Responsibilities A Career At ... to the educational mission as a mentor or preceptor providing didactic and clinical instruction in anesthesia to student nurse anesthetists, medical and dental… more
- CVS Health (Salt Lake City, UT)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- University of Utah Health (Salt Lake City, UT)
- …outcomes. **Responsibilities** + Facilitates the integration of data, information and clinical knowledge to support patient care decision making. + Translates and ... communicates clinical needs to information technology staff and works to...+ Conducts workflow analysis and makes recommendations for change management strategies. + Conducts quality assurance testing prior to… 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 ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… 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. ... shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case... excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Mountain… more
- Deloitte (Salt Lake City, UT)
- … registered nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG ... and informal education of physicians, CDI team, health information management and other clinical staff + Develop...medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical … more
- University of Utah Health (Salt Lake City, UT)
- …degree preferred) **Qualifications (Preferred)** **Preferred** + Licensure as a registered nurse strongly preferred + Management experience + Experience ... for cost savings related to product standardization and improved product utilization by appropriately assisting in the selection, evaluation, monitoring, analysis… more
- Philips (Salt Lake City, UT)
- …etc) with clinical experience as Radiologic Technologist (RT) or Registered Nurse (RN) highly preferred. + Experience in healthcare (in the hospital) within ... **Sales Support, Clinical Specialist - FORS (West/National Travel)** In this...to effectively manage assigned accounts in terms of driving utilization , customer relationship management , problem resolution, etc.… 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
- University of Utah Health (Salt Lake City, UT)
- …of time and attendance of direct reports. + Functions as Case Manager and/or Utilization Review Nurse as necessary. + Tracks and analyzes Case Manager quality ... This position is responsible for the day to day management of the Case Management Department. +...of service and utilization statistics. + Works collaboratively with information systems personnel… more
- Molina Healthcare (West Valley City, UT)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (West Valley City, UT)
- …key health care services (HCS) functions: care management , care transitions, utilization management , behavioral health and/or nurse advice line. ... professionals, in some or all of the following functions: utilization management , care management , care...(RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW),… more
- University of Utah Health (Salt Lake City, UT)
- …trust that are integral to our mission. EO/AA_ + This position provides clinical case management services aimed at enhancing patient-centered care and maximizing ... Health Care Provider card through American Heart Association. + A Certified Case Management designation. + Previous experience in clinical resource management… more
- HCA Healthcare (Salt Lake City, UT)
- …to Patient in Bed by facility by floor to identify opportunities + Assesses utilization of Bed Management technology for optimal use + Analyzes all aspects ... key role in division and facility Emergency Department and Bed Management process improvement projects by performing operational assessments and analyses,… more