- Evolent (Boise, ID)
- …for the mission. Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer , Nurse , you will be a key member of the utilization ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Sharecare (Boise, ID)
- …affordable for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals ... and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- R1 RCM (Boise, ID)
- …position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer ... encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our hospital… more
- Molina Healthcare (Nampa, ID)
- …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… more
- R1 RCM (Boise, ID)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to ... production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal… more
- Elevance Health (Meridian, ID)
- ** Nurse Reviewer I** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum ... integration, and ensures essential face-to-face onboarding and skill development. The ** Nurse Reviewer I** is responsible for conducting preauthorization, out… more
- CVS Health (Boise, ID)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- CVS Health (Boise, ID)
- …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to...**Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- BioLife Plasma Services (Nampa, ID)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. _BioLife Plasma Services is a subsidiary ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… more
- BioLife Plasma Services (Boise, ID)
- …Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife Plasma Services is a subsidiary of ... determine donor eligibility to donate plasma, management of donor adverse events, review of laboratory test results, and donor notification of unsuitable test… 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 ... work of staff. + Participates in supervisory duties including hiring, salary review , competency assessments, staff development, and counseling of employees. + In… more
- R1 RCM (Boise, ID)
- … Appeals Supervisor** , you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical ... policies of the payor. Every day you will supervise the day-to-day clinical operations and functions within the department, ensuring productivity and quality metrics… more
- Sedgwick (Boise, ID)
- …Candidates must live within the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on ... Fortune Best Workplaces in Financial Services & Insurance Remote Accommodations Clinical Specialist- Bilingual Hindi, Japanese, Mandarin or more **We are looking… more
- Molina Healthcare (Nampa, ID)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be given to those… more
- Molina Healthcare (Nampa, ID)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... in consistent and efficient manner. + Makes appropriate referrals to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care… more
- Fresenius Medical Center (Meridian, ID)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...activities. + Enters all treatment data into the designated clinical application accurately and in a timely manner. +… more
- Molina Healthcare (Nampa, ID)
- …in claims auditing, quality assurance, or recovery auditing, ideally in a DRG/ Clinical Validation * 3+ years of Utilization Review and/or Medical Claims ... **Job Description** **Job Summary** The Manager, Clinical DRG Coding & Validation must have an...audit letters, train team members. * Manage medical claim review team nurses, ensure operational goals are meet and… more
- Public Consulting Group (Boise, ID)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... efficient, equitable, and client-centered * Handles case assignments, draft service plans, review case progress, and manages ongoing care needs * Travels within the… more
- Molina Healthcare (Nampa, ID)
- …member benefits, and medical records to document relevant findings of a post pay clinical review . This position manages documents and prioritizes case load to ... Review of applicable policies, CPT guidelines, and provider contracts. + Devise clinical summary post review . + Communicate and participate in meetings… more
- HCA Healthcare (Caldwell, ID)
- …and positive clinical outcomes. As a highly-skilled and compassionate Registered Nurse in the Medical - Surgical Unit you will provide direct patient care. ... and continue to learn! **Job Summary and Qualifications** As a Registered Nurse , you will be responsible for delivering high-quality, patient-centered care in line… more