- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Elevance Health (Meridian, ID)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Title: Utilization Management Representative I** **Location:** This position will...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Humana (Boise, ID)
- …reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable Medical ... Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- Highmark Health (Boise, ID)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- HCA Healthcare (Idaho Falls, ID)
- …is important to you, we encourage you to apply for our Wound Care Nurse opening. Our team will promptly review your application. Highly qualified candidates ... of the range. **Wound Care and Hyperbaric Oxygen Therapy Nurse ** **Clinic is open Monday through Friday from 8...supporting a balance of optimal care and appropriate resource utilization .** + **You will identify potential cause(s) of delayed… more
- HCA Healthcare (Idaho Falls, ID)
- …knowledge and expertise! **Job Summary and Qualifications** As a Wound Care Registered Nurse (RN) you will have the opportunity to use your nursing care experience ... throughput while supporting a balance of optimal care and appropriate resource utilization . + You will identify potential cause(s) of delayed wound healing. +… more
- Humana (Boise, ID)
- …to identify the greatest opportunities for clinical quality measurement (eg, high spend/ utilization clinical areas, etc.). + Review and compile quality measures ... initiatives. **Use your skills to make an impact** **Role Essentials** + Registered Nurse or Pharmacist + 5+ years of clinical experience + Experience working with… more
- Cardinal Health (Boise, ID)
- …plans and meet or exceed cost, quality, clinical and utilization standards, and performance measures. + Oversees Identification, development, implementation, ... (such as patient access & registration, prior auth, medical Records, scheduling, nurse navigation, scribe etc.) + Manages development and maintenance of operational… more
- Travelers Insurance Company (Boise, ID)
- …of creative resolution techniques to improve the claim results of others. + Utilization of Claim Legal Subrogation Counsel as needed. + Actively engage in the ... required to effectively evaluate claims, such as Liability, Risk Control, nurse consultants, Investigative Services, and other experts. OTHER ACCOUNTABILITIES: +… more
- HCA Healthcare (Idaho Falls, ID)
- …campus, service lines). The Vice President ensures the facilitation and utilization of diverse strategies and communication for quality and performance improvement, ... regulatory and accreditation program. **What qualifications you will need:** + Registered Nurse + Bachelors degree in nursing or health-related field required +… more