- CVS Health (Boise, ID)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in CST and MST zones.… more
- Humana (Boise, ID)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...one, (1), year of experience auditing and/or performing case management or utilization management chart… more
- CVS Health (Boise, ID)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Baylor Scott & White Health (Boise, ID)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Molina Healthcare (Caldwell, ID)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Evolent (Boise, ID)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- CVS Health (Boise, ID)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Pharmacy or Medical Surgical** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Boise, ID)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard. **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. - 1+ years' experience in Utilization Review. - CCM and/or other URAC recognized accreditation… more
- Magellan Health Services (Boise, ID)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...Work Experience - Preferred Education - Required Associate - Nursing , Bachelor's - Social Work, Master's - Social Work… more
- Humana (Boise, ID)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Molina Healthcare (Boise, ID)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Trinity Health (Boise, ID)
- …Shift **Description:** **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management / utilization review and discharge planning collaboratively determining ... care as appropriate. Coordinates the hospital activities concerned with case management / utilization review and discharge planning. Adheres to departmental goals,… more
- Trinity Health (Boise, ID)
- …surgery (TACS) patients in collaboration with the trauma surgeon(s), including direct management through utilization of approved protocols and procedures as well ... consultation. The APP will collaborate with the attending surgeon(s) for clinical management of TACS patients, provide direction to nursing personnel regarding… more
- Molina Healthcare (ID)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing . **Required Experience** 3+ years hospital acute care/medical experience.… more
- Molina Healthcare (Boise, ID)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Trinity Health (Boise, ID)
- …collaboration with the orthopedic trauma surgeon(s). The position includes direct clinical management through utilization of approved protocols and procedures as ... Emergency Room, to provide direction to hospital personnel regarding patient management issues, and to manage inpatient orthopedic fracture patients. This individual… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an ... with others. A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3;...responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice… more
- Molina Healthcare (ID)
- …environment that patients feel most comfortable and are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be ... **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home,… more
- Sedgwick (Boise, ID)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more