• RN Medical Claim

    Molina Healthcare (Idaho Falls, ID)
    JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (10/19/25)
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  • Medical Claim Review

    Molina Healthcare (Meridian, ID)
    …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
    Molina Healthcare (09/06/25)
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  • Registered Nurse - Clinical Appeals…

    Cognizant (Boise, ID)
    …role expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
    Cognizant (10/09/25)
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  • Case Manager, Registered Nurse

    CVS Health (Boise, ID)
    …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
    CVS Health (10/15/25)
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  • Investigator, Coding Special Investigative Unit…

    Molina Healthcare (Idaho Falls, ID)
    …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
    Molina Healthcare (10/22/25)
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  • RN Employee Health

    HCA Healthcare (Caldwell, ID)
    …our multi-generational nursing family. We partner with our Nurses at West Valley Medical Center! **Job Summary and Qualifications** The RN Occupational Health is ... Heart Association Basic Life Support + Certified Occupational Health Nurse (COHN) preferred **Benefits** West Valley Medical ...career path, we encourage you to apply for our RN Employee Health opening. We review all… more
    HCA Healthcare (10/22/25)
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  • Nurse Allocator- RN Medicare…

    Sedgwick (Boise, ID)
    …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
    Sedgwick (10/22/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Boise, ID)
    …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
    Lincoln Financial (10/10/25)
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  • Director of Clinical Review Management

    St. Luke's Health System (Boise, ID)
    …for utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and ... is truly a great place to work. The **Director of Clinical Review Management** provides strategic and operational leadership across multiple settings and operating… more
    St. Luke's Health System (10/08/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Boise, ID)
    …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for performing precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director direction, using… more
    Evolent (10/21/25)
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