- Public Consulting Group (Boise, ID)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (Nampa, ID)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Nampa, ID)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Boise, ID)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- Sedgwick (Boise, ID)
- …& Insurance RN Consultant Sr - Professional Liability **Prior Legal Nurse Consulting expereince highly preferred in order to be considered.** **PRIMARY PURPOSE** ... **:** To handle complex or high exposure claim issues; to provide medical knowledge of...Bachelor's degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant)… more
- R1 RCM (Boise, ID)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... and underpaid claims . Every day you will review medical records to ensure appropriate coding...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- Sedgwick (Boise, ID)
- …accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse ( RN ) license required. Current license, ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims , including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Lincoln Financial (Boise, ID)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
- R1 RCM (Boise, ID)
- …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- Otsuka America Pharmaceutical Inc. (Boise, ID)
- …to travel up to 25%.** **Educational Qualifications** Required: + Bachelor's Degree or Registered Nurse ( RN ). Minimum of 10 years industry experience ... and guidance, ICH/GCP, and Otsuka SOPs.** **Contribute to the development and review of all critical clinical study documents, including clinical protocols, informed… more
- Lincoln Financial (Boise, ID)
- …duties as required. **What we're looking for** * Minimum of 5 years of disability claims experience * Current Registered Nurse license or Licensure in ... you will be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes partnering closely with… more
- Lincoln Financial (Boise, ID)
- …at a Glance** We are excited to bring on a Clinical Director to our claim 's organization. This role will be remote, or hybrid based on the proximity to Charlotte ... stakeholders that require collaboration with resources from clinical and claims . * Directs operational workforce & volume analysis, including analysis… more
- Sedgwick (Boise, ID)
- …new business plan with goals and objectives for assigned locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff. ... cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines; and to provide expertise… more
- Trinity Health (Boise, ID)
- …experience required. + Minimum of three years' experience in healthcare. ** RN required.** **Hours:** Flexible daytime, traditional office hours. There will be ... remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review . + Expert in Apparent Cause Analysis (ACA) and Common Cause… more