Currently licensed as a Registered Nurse (RN) in the State of Utah, in good standing, with at least three (3) years of combined experience in a broad spectrum of nursing, utilization review, and/or medical case management OR currently a Licensed Practical Nurse (LPN) in the state of Utah, in good standing, with at least five (5) years of combined experience in a broad spectrum of nursing, utilization review, and/or medical case management. The role requires reviewing claims data, coordinating care with members and providers, documenting activities in PEHP systems, evaluating alternative benefits, supporting adjusters with claims accuracy, providing outcome and cost-saving reports, serving as a resource for staff, interpreting clinical information to apply PEHP policy, auditing claims, and maintaining strict confidentiality.