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
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
Case Management/Utilization Review
801-587-6480, Option 2