Utilization Review Rn Jobs in Utah (NOW HIRING)

Job Title

This position is a hybrid role that combines the roles and expertise of Utilization Review and Care management. This role is essential in ensuring that members receive high-quality, cost-effective care. Overall, utilization management is an essential process that not only ensures the medical necessity of care but also assists in monitoring and controlling healthcare costs while prioritizing member safety. These processes involve detailed assessments, evidence-based guidelines, and coordination among various healthcare professionals to achieve optimal outcomes for members. The ideal candidate will possess a strong understanding of utilization management principles, as well as a solid foundation in healthcare operations and regulatory compliance. Candidates will apply expertise to review medical records and treatment plans for individuals with specific conditions or diagnosis including medical and behavioral health conditions to ensure that services are medically necessary, appropriate, and cost-effective.

Job Description

Pay Range LCSW: $38.77 - $59.82 Exempt

Benefits Eligible: Yes

FTE: Full time

Shift: Hybrid Role. Monday - Friday, 8:00am - 4:30pm. (Schedule finalized on hire) Occasional weekends and Holidays.

REQUIRED LCSW LICENSURE

Essential Functions

• Utilization Review and Care Management of members with specific treatment plans, conditions, or diagnosis including medical and behavioral health conditions
• Provide ongoing training and support to families and caregivers.
• Collect, analyze, and interpret data to evaluate the effectiveness of interventions.
• Stay current with the latest research and best practices in assigned population.
• Inform Select Health Medical and Behavioral Health policy and procedure.
• Peer to Peer and Peer review to evaluate and influence the work of others in the field to ensure adherence to ethical standards, best practices, and regulatory requirements.
• Occasional travel to provider locations within Select Health region.
• Review medical records to determine the medical necessity of services.
• Evaluate the appropriateness of procedures, diagnostic assessments, functional behavior assessments, and treatment plans.
• Make timely and informed determinations about the medical necessity and appropriateness of services.
• Adhere to regulatory requirements, payer guidelines, and ethical standards.
• Facilitate Communication, Organize Collaborative Meetings, and Resolve Conflicts with healthcare providers to ensure coordinated member care.
• Communicate with members, families, and insurance representatives.
• Conduct comprehensive assessments of members' needs.
• Develop and implement individualized care plans.
• Educate and empower members and families.
• Advocate for members' rights and access to care.
• Monitor and evaluate the effectiveness of care plans.

Minimum Qualifications

• Master's degree in Social Work
• Current licensure or Certification in Utah: LCSW
• Candidates may be required to obtain a licensure in others states in Select Health region within 90 days of employment.
• Demonstrated clinical expertise and experience in related behavioral health field.
• Minimum 1 year experience in Utilization management or closely related field including: Utilization Review, Case Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator job role.
• Intermediate computer and hardware set-up, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications.

Preferred Qualifications

• Three years of experience and expertise working in clinical Behavioral Setting or Utilization Management.
• Ability to work independently and be flexible in a rapidly changing environment.
• Demonstrated excellent written and verbal communication skills.
• Experience working successfully in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook;
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
• Knowledge of healthcare insurance and utilization review processes.
• Knowledge of regulatory requirements, such as NCQA, CMS, and state-specific regulations and legislation related to field.
• Ability to travel as needed.

Physical Requirements

• Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with colleagues and providers require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
• May be expected to sit or stand in a stationary position for an extended period of time.

Location

SelectHealth - Murray

Work City: Murray

Work State: Utah

Scheduled Weekly Hours: 40

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

$38.77 - $59.82

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.

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.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.