- Elevance Health (Boise, ID)
- …send you a check, or ask you for payment as part of consideration for employment. ** Utilization Management Rep II** + Job Family: CUS > Care Support + Type: Full ... + Ohio + Missouri + Kentucky + Florida **Description** ** Utilization Management Rep II** **Location: This is...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Humana (Boise, ID)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge… more
- R1 RCM (Boise, ID)
- …of the evidence-based criteria. The successful candidate will have hospital-based Utilization Review or Case Management experience. **Responsibilities:** + ... delivery **Required Qualifications:** + Must have a current Registered Nurse license in your state of residence + At...residence + At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred… more
- St. Luke's Health System (Boise, ID)
- …at the lowest total cost of care. SLHP is accountable for the management of medical spend and quality outcomes of defined populations through value-based agreements ... + Works closely with the physician, care team and payers in the management of identified patient populations to reduce the total cost of care and… more
- Molina Healthcare (Twin Falls, ID)
- …program for new Grads!* *Molina Student Loan Payment program available to Nurse Practitioners* **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse ... are most receptive including home, nursing facilities, and "pop up" clinic. The Nurse Practitioner will be required to work primarily in non-clinical settings and… more
- Behavioral Health Solutions (Boise, ID)
- …culture with hands-on leadership. BHS is currently seeking an experienced Psychiatric Nurse Practitioner (PMHNP) licensed in Idaho to join our team in the ... role of Lead Nurse Practitioner. Responsibilities: Leadership and Training + Provide guidance,...evaluate the use of psychotropic drugs and ensure proper utilization with nursing home patients. Clinical Responsibilities: + Conduct… 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 ... The APP will collaborate with the attending surgeon(s) for clinical management of TACS patients, provide direction to nursing personnel regarding patient… more
- Trinity Health (Boise, ID)
- …outpatient clinic. The APP will collaborate with the neurosurgeons for clinical management of neurosurgery patients through utilization of approved protocols and ... office visits, assisting with surgical cases, supporting the IR workflow, and management of patients post operatively in an inpatient setting. Work will occur… more
- Marriott (Boise, ID)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Nurse CARE Manager coordinates timely, ... **Additional Information** Nurse CARE (coordinated action and response) Manager **Job...Claims Services + Collaborate with Claims department regarding case management . + Collaborate with UNM on utilization … more
- J&J Family of Companies (Boise, ID)
- …raising the bar on customer experience in the pharmaceutical industry. Our account management teams support the certified sites who care for cancer patients. We are ... Therapy Experience Lead is a member of this account management team, reporting to the Senior Manager, CAR-T Cell...a portfolio of certified sites, facilitating successful CARVYKTI(R) product utilization of the sites by advising them on order… more
- Magellan Health Services (Pocatello, ID)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... care. * Maintains a caseload of members enrolled in the case management program, including risk stratification of members, monitoring reassessment needs and… more
- Magellan Health Services (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...Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more
- Magellan Health Services (ID)
- …Includes additional departmental responsibilities and tasks such as learning management system administrator, training material development and maintenance, audit ... company policies, COE and site procedures and systems, and clinical care management processes. + Provides classroom and/or one-on-one instruction for new employees… more
- Surgery Care Affiliates (Boise, ID)
- …and differentiated ways as part of Optum and with our new Specialty Management Solutions business. + We have pioneered a physician-led, multi-site model of practice ... the needs of the physician and keeping the circulating nurse informed of any needs throughout a procedure. +...all new equipment requests are appropriately analyzed based on utilization and data from the provider. + Maintain radiation… more
- Magellan Health Services (Boise, ID)
- …Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management , quality assurance, home or facility care, community ... in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit...Clinical Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care Mgmt… more