Care Management and Utilization Management

Care manager nurses help people with their health care and community service needs, at the right time, right setting and for the best value. We are conscientious to the cultural and linguistic preferences of our members and their supports.

Our Care Management program offers our members individual attention to help meet their health care goals. Services include education, advocacy, and coordination of your needed services. This program is no-cost for our members who want care management nursing services.

If you have a serious or chronic condition and would like care management services, please call 1-888-271-5870, option 2.  Our staff members are available for members and providers. The hours of operation are Monday through Friday 8 am to 6 pm (excluding holidays). TDD/TTY services are available. You may contact Utah Relay Services at 711 or 1-800-346-4128 if you need support for hearing or blindness. Language assistance is available, free of charge.  Our fax number is 801-281-6121.  Providers may also submit a request or additional information online through our website.  For more information click here.

 

Our Utilization Management Team assists members to get the right care at the right time to allow for the best outcome based on nationally recognized evidence-based guidelines.  Your doctor is required to get prior authorization for some services.  You or your doctor can request an expedited response if a delay could be hazardous for you.  In some situations, a service may be reviewed for medical necessity and coverage after the service is rendered.  Members have the right to request an appeal or reconsideration of all Utilization Management decisions.  Services that require a referral or authorization are listed here.

If you would like to learn more about our Utilization Management program, please call 1-888-271-5870, option 2.  Our staff members are available for members and providers. The hours of operation are Monday through Friday 8 am to 6 pm (excluding holidays). TDD/TTY services are available. You may contact Utah Relay Services at 711 or 1-800-346-4128 if you need support for hearing or blindness. Language assistance is available, free of charge.  Our fax number is 801-281-6121.  Providers may also submit a request or additional information online through our website.  For more information click here.

Case Management/Utilization Review

801-587-6480, Option 2

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Provider information in this directory is collected from information that we receive from our provider network and updated 5 days per week, excluding weekends, holidays, or interruptions due to upgrades, system maintenance, or unplanned outages. This information is subject to change at any time.