- Evolent (Boise, ID)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Nampa, ID)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for medical ... and cost-effective member care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical / medical reviews of retrospective medical ...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- St. Luke's Health System (Boise, ID)
- …St. Luke's is truly a great place to work. **What to Expect:** The Clinical Research Nurse will support the Cardiology Research Department in both the ... is primarily in heart failure, arrhythmia, ACS/MI/CAD, and dyslipidemia studies. The Clinical Research Nurse is responsible for identifying eligible patients for… more
- Humana (Boise, ID)
- …Manager, Fraud and Waste Investigator: Nurse Audit/ Review performs clinical audit/validation processes to ensure that medical record documentation and ... approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to… more
- Humana (Boise, ID)
- …needs and by providing guidance along the healthcare continuum. You will perform clinical case review on members during an inpatient hospital admission. You ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...+ Bilingual is a plus - preferably Spanish + Clinical claim review experience **Additional Information** +… more
- Trinity Health (Boise, ID)
- …Forbes as one of **America's Best Large Employers for 2025** , is looking for a ** Nurse Unit Supervisor** to join our team at our Level II Trauma Center in **Boise, ... . This position will be located at our Regional Medical Center (https://www.saintalphonsus.org/location/saint-alphonsus-regional- medical -center) off I-184 and Curtis… more
- BioLife Plasma Services (Boise, ID)
- …You will report to the Plasma Center Manager and will perform as a Medical Support Specialist (Plasma Center Nurse ) to support plasma center operations. BioLife ... of laboratory test results, and donor notification of unsuitable test results. The Medical Support Specialist (Plasma Center Nurse ) works under the guidance of… 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 ... shift operations, quality of care, staffing, program development and evaluations and medical staff relations. + Collaborates with Manager and QA representative to… 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 ... shift operations, quality of care, staffing, program development and evaluations and medical staff relations. + Collaborates with Manager and QA representative to… more
- Surgery Care Affiliates (Boise, ID)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Highmark Health (Boise, ID)
- …over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and ... utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts… more
- Cardinal Health (Boise, ID)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Boise, ID)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Magellan Health Services (Boise, ID)
- Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive ... care management staff, providing expertise in designated programs. + Assists clinical management in the development and on-going management of designated staff. +… more
- Molina Healthcare (Nampa, ID)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Nampa, ID)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more
- Molina Healthcare (Nampa, ID)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- Molina Healthcare (Nampa, ID)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- Molina Healthcare (Nampa, ID)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Nampa, ID)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more