- Evolent (Boise, ID)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Boise, ID)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ID, ... (SHW) inNampa, Idaho! We are currently seeking a dedicated and experiencedRegistered Nurse Seniorto take on a critical role in our Utilization Review, Performance… more
- Molina Healthcare (Meridian, ID)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- St. Luke's Health System (Boise, ID)
- …patient-centered care. **_We are currently hiring for a Full-Time (1.0 FTE) Registered Nurse with at the Children's Endocrinology Clinic located in Boise at The ... in-basket tasks such as triaging patient concerns, handling prior authorizations, and coordinating appeals . This role offers a dynamic mix of direct patient care and… more
- Molina Healthcare (Boise, ID)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more