- CenterWell (Salt Lake City, UT)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Salt Lake City, UT)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Intermountain Health (Murray, UT)
- …Case management Certification. - and - Experience in Case management , Utilization review, and/or discharge planning. **Physical Requirements:** Ongoing need ... **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical...in area(s) of responsibility. Completes documentation as required. Performs utilization review activities to provide patient appropriate, timely, and… more
- Evolent (Salt Lake City, UT)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Molina Healthcare (Salt Lake City, UT)
- …(EMR) experience. Preferred Qualifications * Experience as a registered nurse or nurse practitioner in a home health, community health or public health ... in home health as a licensed clinician, especially in management of chronic conditions. * Experience with underserved populations facing socioeconomic barriers… more
- Molina Healthcare (Provo, UT)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... must be technologically proficient, self-directed, autonomous and experience working from home . Care Management & Waiver Service Auditing experience is… more
- Evolent (Salt Lake City, UT)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- University of Utah Health (Salt Lake City, UT)
- …discharge plans prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care facilities, durable ... 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
- Molina Healthcare (Provo, 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 (Provo, 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
- 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 ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… 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 ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). + Delaware RN license must...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- University of Utah Health (Salt Lake City, UT)
- …integral to our mission. EO/AA_ + This position provides clinical case management services aimed at enhancing patient-centered care and maximizing outcomes across ... the patient care continuum from pre-admission through post-discharge. + Case management services include monitoring patient care to ensure progress toward desired… more
- Sharecare (Salt Lake City, UT)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Molina Healthcare (Provo, UT)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...hold a compact license. This is a Remote position, home office with internet connectivity of high speed required… more