- Humana (Boise, ID)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... 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 Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Boise, ID)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Boise, ID)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Boise, ID)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Idaho Division of Human Resources (Nampa, ID)
- …is responsible for planning, developing, implementing, and administering an effective Utilization Management Program. This program ensures compliance with all ... Utilization Review and Nurse Educator -...+ Collaborate with leadership to evaluate and enhance the Utilization Management Program, ensuring quality care and… more
- CVS Health (Boise, ID)
- …+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization ... members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the… more
- Elevance Health (Meridian, ID)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …in the CLC. Documents and takes corrective action when notified by the CLC management team, charge nurse , or designee of any discrepancies in coding or ... Summary The Nurse (Community Living Center) executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Molina Healthcare (Nampa, ID)
- **JOB DESCRIPTION** **Job Summary** The Care Connections Nurse Practitioners focus on screening and preventive primary care services delivered in the home, ... 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
- Molina Healthcare (Nampa, ID)
- …post-discharge coordination to reduce hospital readmission rates and emergency room utilization . * Performs face-to-face in-person visits in a variety of settings ... states besides home state based on business need. * Collaborates with fellow nurse practitioners to develop best practices to perform work duties efficiently and… more
- Molina Healthcare (Nampa, ID)
- …of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, physicians and member/provider inquiries/appeals. ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment… more
- Highmark Health (Boise, ID)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Boise, ID)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (Nampa, ID)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… 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
- Molina Healthcare (Nampa, 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
- Highmark Health (Boise, ID)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Molina Healthcare (Nampa, 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