Role Description As a Registered Nurse RN Utilization Management Care Reviewer, you will be working in partnership with the Medical Director to evaluate patient care, conduct reviews, and identify issues that may delay patient services, ensuring exceptional care is being delivered. You will collaborate with Ambulatory Case Management and Facility Case Managers to ensure safe and proper coordination upon discharge from facilities. This position, within the Utilization Management Department, will determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines. This position will interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations. In addition to pre-service, admission, and concurrent review determinations, this position will be responsible for managing length of stay, discharge planning, resources, and identification of potential quality of care or safety concerns. Core Functions - Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines. - Analyzes clinical services from members or providers against evidence-based guidelines. - Identifies appropriate benefits, eligibility, and expected length of stay for requested services, treatments, and/or procedures. - Conducts inpatient reviews to determine financial responsibility. May also perform authorization reviews and/or related duties as needed. Processes requests within required timelines. - Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. Makes appropriate referrals to other clinical programs. - Collaborates with multidisciplinary teams to promote Banner Health's Integrated model. - Adheres to UM policies and procedures. Qualifications - Bachelor’s degree in nursing or equivalent working knowledge. - Active, unrestricted State Registered Nursing (RN) license in good standing. - MCG certification or ability to obtain within six months of hire. - Five years of clinical nursing experience or equivalent working knowledge. - Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms. - Must be highly proficient in medical record review including EMR and paper/fax platforms. Requirements - Critical care experience (ICU/ER/flight/PACU). - Must be able to work independently. - Basic knowledge of EMRs and the Microsoft platform. - Strong comfort level with computers, basic IT skills, and a reliable internet connection. - Must live in the state of AZ to be considered. Preferred Qualifications - Two to three years of Utilization Management experience using MCG, CMS, and clinical criteria. - MSN preferred. - Case Management Certification (CCM or RN-BC or CMCN). - Utilization Management Certification. - Certified Professional in Healthcare Quality Certification (CPHQ). - Experience with Medicare Advantage, ACOs, Commercial, Dual Eligible, AHCCCS, and/or ALTCS. - Experience with URAC and NCQA accreditation process. - Experience using Medical Management software platforms. - Additional related education and/or experience preferred. Benefits - Health and financial security options. - Variety of benefit plans to help you and your family. Estimated Pay Range $37.14 - $61.90 / hour EEO Statement EEO/Disabled/Veterans. Our organization supports a drug-free work environment.

Role Description The RN Triage and Message Management provides remote clinical support for outpatient practices by performing telephonic triage and managing outpatient messages in the electronic health record (EHR) and patient portal. This role uses evidence-based triage protocols and nursing judgment to: - Assess symptoms and determine urgency - Provide patient education and self-care guidance - Coordinate timely follow-up and escalate care when indicated The RN supports safe, efficient, patient-centered care by ensuring: - Accurate documentation - Timely message resolution - Close collaboration with providers and the interdisciplinary care team The RN also supports value-based care initiatives through: - Proactive panel support - Care coordination - Workflows that improve access, close care gaps, and promote quality outcomes and patient experience Qualifications - Current Registered Nurse (RN) license in state of practice - Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required) - Demonstrated clinical nursing experience in chronic disease management - Familiarity with chronic disease terminology and processes - Basic computer skills and knowledge of Microsoft Office software Requirements - Must live within 20-30 minutes from Intermountain Health care site (Hospital or clinic) - Full Time, Monday - Friday 8:00 - 5:00 - No weekends/holidays/evenings or graves - No on-call requirements - Fully Remote (must reside in Colorado or Montana) Benefits - Generous benefits package covering a wide range of programs - Focus on fostering a sustainable culture of wellness Company Description 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. 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.

Role Description We are seeking an experienced Medical Credentialing Specialist to help support our team with the end-to-end credentialing and re-credentialing process for healthcare providers across multiple U.S. states. This role is critical to ensuring our clients' providers are properly enrolled with insurance payers, enabling timely and accurate reimbursement. The ideal candidate has strong CAQH management experience and a proven track record in multi-state payer enrollment. Key Responsibilities - Manage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. states - Complete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-ready - Submit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programs - Monitor credentialing timelines, follow up on pending applications, and escalate delays to ensure providers are enrolled before their start dates - Maintain organized credentialing files including licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation - Coordinate with providers and practice managers to collect and verify required documentation - Track and manage license and certification expiration dates, initiating renewals proactively - Research and resolve payer enrollment issues, denials, and discrepancies - Stay current on payer-specific enrollment requirements, state regulations, and CMS guidelines - Prepare and submit roster adds/changes for group enrollments - Generate regular status reports on credentialing activities and turnaround times Qualifications - 2-5 years of hands-on medical credentialing and payer enrollment experience - Strong working knowledge of CAQH ProView, PECOS, and NPPES/NPI systems - Demonstrated experience with multi-state credentialing (enrollment across 3+ U.S. states) - Familiarity with commercial payer enrollment processes (UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana, etc.) - Experience with Medicare and Medicaid enrollment procedures - Proficiency in credentialing software and practice management systems - Excellent attention to detail and organizational skills - Strong written and verbal English communication skills - Ability to manage multiple provider files and deadlines simultaneously - Reliable internet connection and dedicated home office setup for remote work Preferred Qualifications - Experience working with U.S.-based medical billing or RCM companies - Knowledge of provider contracting and fee schedule negotiation basics - CPCS (Certified Provider Credentialing Specialist) or CPMSM certification - Experience with EHR/PM systems such as eClinicalWorks, Athena, or AdvancedMD - Familiarity with hospital privileging processes

Provide quality care by making effective clinical judgments in various healthcare settings. Serve diverse populations through immunization, wellness, and travel health clinics, ensuring compliance with health regulations and professional standards.