Jobs search

JOB DETAILS

Registered Nurse Utilization Review

SelectHealth Inc • Full-time • Murray, Utah, United States • $39.99 - $59.18 / hour • 6d ago

Job Description:

SelectHealth is a not-for-profit community health plan serving more than 1 million members in the intermountain west that offers a variety of Medicare, Medicaid, Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary.

Job duties include:

Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.
Applies evidence-based guidelines (e.g. InterQual) and medical policies with prior authorization and concurrent reviews and follows the applicable regulatory guidelines (NCQA, CMS) to provide clear and timely communication to members and requesting providers
Identifies members for referral opportunities to integrate with other products, services and/or programs
Collaborates with physicians, internal staff, members and members' families to assist in expediting appropriate discharge, obtains authorizations, and directs toward medically necessary care. Resolves member, family/caregiver assistance requests.

Minimum Qualifications

Current RN license in state of practice.
Three years clinical nursing experience.
One year in Managed Care, Utilization Management, or Case Management.
Basic computer skills including word processing and spread sheets.
Excellent organizational, written, and interpersonal skills and the ability to anticipate and solve problems and communicate clearly and effectively.
RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.

Preferred Qualifications

Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified.
Current working knowledge of Medicare, Medicaid and Commercial insurance.
Current working knowledge of utilization management and case management techniques.
Working understanding of coding or utilization management criteria (i.e., InterQual, CMS manual).
Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.

Physical Requirements:

Ongoing need for employee to see and read information, assess member needs and view computer monitors.

- and -

Frequent interactions with providers, members that require employee to verbally communicate as well as her and understand spoken information, needs and issues accurately.

Anticipated job posting close date:

07/22/2024

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$39.99 - $59.18

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment todiversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Related Jobs

ICU RN

MountainStar Healthcare • Full-time • Salt Lake City, UT, United States • 2w ago

RN ICU

Description Introduction Are you looking for a place to deliver excellent care patients deserve? At St. Marks Hospital we support our colleagues in their positions. Join our Team as a(an) ICU RN and access program... more

2w ago

VIEW JOB

Director of Nursing

Outfield Healthcare Partners • Full-time • Salt Lake City, UT, US • 2w ago

*Benefits available for Full Time employee’s* *Salary Census: Flucuates betwen 78-80. Location: New Mexico (We have two vacancies for our newest acqusitions!) Truth or Consequences... more

2w ago

VIEW JOB

Registered Nurse Acute Per Diem- Dialysis Experience Required!

DaVita • Per Diem • Salt Lake City, Utah 84108, United States • 1m ago

423 S Wakara WaySte 200, Salt Lake City, Utah, 84108-3534, United States of America DaVita is seeking a Registered Nurse who is looking to give life in a hospital setting. You can make an exceptional difference in the... more

1m ago

VIEW JOB

New Grad RN Operating Room

MountainStar Healthcare • Full-time • Draper, UT, United States • 2w ago

RN OR New Grad

Description Introduction Lone Peak Hospital in Draper, Utah has an opening for a New Grad RN who will graduate by September 20, 2024 and who has completed, or is currently completing, a capstone in... more

2w ago

VIEW JOB

New Grad RN Operating Room

MountainStar Healthcare • Full-time • Salt Lake City, UT, United States • 2w ago

RN OR New Grad

Description Introduction St. Marks Hospital in Salt Lake City, Utah has an opening for a New Grad RN who will graduate by September 20, 2024 and who has completed, or is currently completing, a capstone... more

2w ago

VIEW JOB

Registered Nurse (RN)

Mission Healthcare • Full-time • Salt Lake City, UT • 3w ago

RN Home Health

Currently, we are looking for Registered Nurses to join our team who would like to combine their love for people and excellent clinical skills with the opportunity to advance your career. Our Registered Nurses plan,... more

3w ago

VIEW JOB

PRN Home Infusion Nurse - Monticello

Naven Health • Per Diem • Salt Lake City, UT • 1m ago

RN Infusion

Delivering an exceptional infusion experience, everywhere. Delivering on our unyielding commitment, always. Naven Health is a nationwide home infusion nursing network and clinical platform focused on delivering s... more

1m ago

VIEW JOB

Case Manager Licensed Professional (RN) Hospice FT

Enhabit Home Health & Hospice • Murray, UT, US • 2m ago

RN Hospice Home Health

Overview Are you in search of a new career opportunity that makes a meaningful impact? If so, now is the time to find your calling at Enhabit Home Health & Hospice. As a national leader in home-based care, Enha... more

2m ago

VIEW JOB

Registered Nurse PD Intermediate

DaVita • Full-time • Salt Lake City, Utah 84108, United States • 1w ago

RN Home Health

423 S Wakara WaySte 200, Salt Lake City, Utah, 84108-3534, United States of America We are looking for a self-motivated, organized individual who is passionate about patient care and excited for the opportunity to inde... more

1w ago

VIEW JOB

Life Flight Registered Nurse Neonatal

IHC Health Services Inc • Full-time • Salt Lake City, Utah, United States • $39.99 - $59.18 / hour • 1w ago

Job Description: The Flight Nurse demonstrates advanced critical thinking capabilities in working autonomously and in collaboration with other health care providers in the delivery of care to critically ill patien... more

1w ago

VIEW JOB