- Evolent (Boise, ID)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Caldwell, ID)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely ... Friday 8:00am - 5:00pm. **Essential Job Duties** * Performs clinical / medical reviews of retrospective medical ...hospital setting, including at least 1 year of utilization review , medical claims review , claims… more
- Molina Healthcare (Caldwell, ID)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Cognizant (Boise, ID)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- St. Luke's Health System (Boise, ID)
- …St. Luke's is truly a great place to work. **What to Expect:** The Clinical Research Nurse will support the Cardiology Research Department in both the ... is primarily in heart failure, arrhythmia, ACS/MI/CAD, and dyslipidemia studies. The Clinical Research Nurse is responsible for identifying eligible patients for… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities NOTE: The 2-page Resume requirement does… more
- Trinity Health (Boise, ID)
- …Forbes as one of **America's Best Large Employers for 2025** , is looking for a ** Nurse Unit Supervisor** to join our team at our Level II Trauma Center in **Boise, ... . This position will be located at our Regional Medical Center (https://www.saintalphonsus.org/location/saint-alphonsus-regional- medical -center) off I-184 and Curtis… more
- CVS Health (Boise, ID)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- CVS Health (Boise, ID)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care… more
- Molina Healthcare (Caldwell, ID)
- … medical officer. * Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review and manages the denial ... * Collaborates with contracting department in contract negotiations. * Fosters clinical practice guideline implementation and evidence-based medical practices. *… more
- BioLife Plasma Services (Boise, ID)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… more
- Trinity Health (Boise, ID)
- …services to patients, physicians, and appropriate customer groups. + Functions as a clinical expert within the service area and assists the unit Manager in the ... shift operations, quality of care, staffing, program development and evaluations and medical staff relations. + Collaborates with Manager and QA representative to… more
- Trinity Health (Boise, ID)
- …services to patients, physicians, and appropriate customer groups. + Functions as a clinical expert within the service area and assists the unit Manager in the ... shift operations, quality of care, staffing, program development and evaluations and medical staff relations. + Collaborates with Manager and QA representative to… more
- Surgery Care Affiliates (Boise, ID)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Cardinal Health (Boise, ID)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Boise, ID)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Magellan Health Services (Boise, ID)
- Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive ... care management staff, providing expertise in designated programs. + Assists clinical management in the development and on-going management of designated staff. +… more
- Molina Healthcare (Caldwell, ID)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Caldwell, ID)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent… more
- Molina Healthcare (Caldwell, ID)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more