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Insurance Utilization Reviewer Jobs in Utah (NOW HIRING)

Health, dental, vision, and life insurance. 401(k) savings plan. PTO. Responsibilities: - Utilizes ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

Health, dental, vision, and life insurance. 401(k) savings plan. PTO. Responsibilities: - Utilizes ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

Health, dental, vision, and life insurance. 401(k) savings plan. PTO. Responsibilities: - Utilizes ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

Dispatch Manager

Orem, UT · On-site

$82K - $99K/yr

Medical, Dental, Vision, Life, AD&D Insurance * Paid Vacation, Holidays, and Sick Time * 401k ... This position oversees drivers, fleet utilization, delivery scheduling, regulatory compliance ...

Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan ... Certification in case management or utilization review preferred. * InterQual experience preferred.

Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan ... Certification in case management or utilization review preferred. * InterQual experience preferred.

Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan ... Certification in case management or utilization review preferred. * InterQual experience preferred.

Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan ... Certification in case management or utilization review preferred. * InterQual experience preferred.

Showing results 41-60

Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are popular job titles related to Insurance Utilization Reviewer jobs in Utah?

For Insurance Utilization Reviewer jobs in Utah, the most frequently searched job titles are:

Staff Pharmacist - Salt Lake City, UT, Amazon Pharmacy

Amazon

Salt Lake City, UT • On-site

$57.50 - $67.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago


Amazon rating

7.4

Company rating: 7.4 out of 10

Based on 7,151 frontline employees who took The Breakroom Quiz

5th of 39 rated national retailers


Job description

Innovation is at the core of what we do. We believe that by removing and reducing the barriers that
prevent people from taking their medications, we can help customers conveniently get the
medications they need, when they need them and take them as prescribed. We have provided
customers with the ability to find transparent and simple pricing, receive 24/7 customer service
support, and have their meds delivered to their doorsteps while creating programs and products
that embody our mission and position ourselves in becoming the world's safest and fastest online
pharmacy.
We are looking for a Staff Pharmacist to join us on our journey to make it drastically easier for
customers to find, choose, afford, and engage with the services, products, and professionals they
need to get and stay healthy!
Work schedule: Monday - Friday 6:00am - 2pm
#everydaybetter
Key job responsibilities
• Perform clinical data review, prescription verification, and virtual patient consultations in
compliance with state and federal regulations
• Manage end-to-end prescription fulfillment process, including dispensing medications
using automated systems (Parata Max2) and manual fill
• Package and prepare prescriptions for shipment or site injection, including handling of
specialized medications (refrigerated and bulk items)
• Maintain strict quality standards and safety protocols while meeting Critical Pull Times
(CPT) and production targets
• Split time effectively between prescription verification and fulfillment duties based on
operational needs and customer centric volume
• Perform thorough DUR (Drug Utilization Review) and ensure accurate documentation in
pharmacy systems
• Monitor, receive, and manage pharmacy inventory effectively and compliantly
• Work collaboratively with pharmacy technicians and other pharmacists to maintain
efficient workflow
• Demonstrate strong attention to detail and adapt to changing priorities in a fast-paced
environment
• Support operational excellence initiatives and continuous improvement efforts
• Identify and report quality or safety concerns promptly while maintaining compliance with
all regulatory requirements
• Complete daily operational tasks including processing returns, medication rejects,
therapeutic substitutions, and canister approvals
Physical Requirements:
During Peak/high demand, shifts last up to 12 hours (standard full-time shifts are 8-10 hours)
• Standing, bending, reaching above the head, kneeling, crouching and/or stretching
• Lifting and moving products up to 49 lbs in weight
• Manual dexterity of hands and wrists
• Walking throughout the Amazon building for various reasons such as injections and inventory receive
BASIC QUALIFICATIONS
- Bachelor's degree in Science, or Doctor of Pharmacy in PharmD, or Doctor of Pharmacy
- Knowledge of pharmacy laws and federal/state regulations concerning patient care
- Can have an active and unrestricted pharmacist license in your state of employment (additional licenses may be required)
- Proficiency with basic computer functions and pharmacy systems
PREFERRED QUALIFICATIONS
- Exemplary interpersonal, written, and verbal communication skills
- Demonstrated ability to work as an effective team member
- Demonstrated organization skills and attention to detail
- Experience working under pressure in a fast-paced work environment while consistently meeting standards for productivity and quality
Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status.
Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you're applying in isn't listed, please contact your Recruiting Partner.
The base salary range for this position is listed below. Your Amazon package will include sign-on payments and restricted stock units (RSUs). Final compensation will be determined based on factors including experience, qualifications, and location. Amazon also offers comprehensive benefits including health insurance (medical, dental, vision, prescription, Basic Life & AD&D insurance and option for Supplemental life plans, EAP, Mental Health Support, Medical Advice Line, Flexible Spending Accounts, Adoption and Surrogacy Reimbursement coverage), 401(k) matching, paid time off, and parental leave. Learn more about our benefits at https://amazon.jobs/en/benefits.
USA, UT, SALT LAKE CITY - 103,800.00 - 146,400.00 USD annually

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About Amazon

Sourced by ZipRecruiter

Amazon.com, Inc., commonly known as Amazon, is an American multinational technology company. It was founded by Jeff Bezos in 1994 and initially started as an online marketplace for books. Since then, Amazon has expanded its operations and become one of the largest e-commerce companies in the world. Amazon's primary business is its online retail platform, where customers can purchase a vast array of products, including electronics, clothing, books, home goods, and much more. The company offers a convenient and user-friendly shopping experience, with features such as fast shipping, customer reviews, and personalized recommendations. In addition to its e-commerce platform, Amazon has diversified its business into various other areas. One of its notable ventures is Amazon Web Services (AWS), a comprehensive cloud computing platform that provides services such as storage, compute power, and database management to individuals and businesses. AWS has become a leader in the cloud computing industry, powering many websites and applications worldwide. Amazon has also developed its own consumer electronics, including the popular Amazon Kindle e-reader, Fire tablets, Fire TV streaming devices, and the Alexa-powered Echo smart speakers. The Alexa voice assistant, integrated into these devices, allows users to interact with their devices using voice commands, perform tasks, and access information. Furthermore, Amazon has expanded into media and entertainment. It operates Prime Video, a streaming service that offers a wide range of movies, TV shows, and original content. Amazon Music provides a platform for streaming and purchasing digital music, while Audible offers audiobooks and other audio content. The company's commitment to customer satisfaction and convenience is demonstrated by its membership program, Amazon Prime. Prime members receive various benefits, including free two-day shipping, access to streaming services, exclusive deals, and more.

Industry

It services, book publishers, retail, real estate, computer and electronic product manufacturing and software development

Company size

10,000+ Employees

Headquarters location

Seattle, WA, US