"Alerted.org

Utilization Review and Nurse Educator - SHW

Posting Begin Date: 2025/09/22

Posting End Date: 2025/10/20

Category: Nursing

Work Type: Full Time

Minimum Salary: 37.60

Maximum Salary: 37.60

Pay Rate Type: Hourly

Description

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

***THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.

Come join a great team at State Hospital West (SHW) inNampa, Idaho! We are currently seeking a dedicated and experiencedRegistered Nurse Seniorto take on a critical role in our Utilization Review, Performance Improvement, Nursing Education programs. This is an exciting opportunity to be part of a multidisciplinary team that is making a meaningful difference in the lives of youth across Idaho. Under the direction and supervision of the Director of Performance Improvement and Accreditation, this position is responsible for planning, developing, implementing, and administering an effective Utilization Management Program. This program ensures compliance with all applicable federal, state, and local regulations, including licensure requirements, The Joint Commission accreditation standards, and CMS rules—all with the goal of supporting and maintaining high-quality care for our adolescent patients as well as overseeing utilization review, this position includes responsibilities for researching, developing, and interpreting rules, policies, and procedures; recommending program improvements; and contributing to the hospital’s mission of continuous performance improvement.

State Hospital West is a 16-bed Adolescent Psychiatric Treatment Hospital, serving patients between the ages of 11 and 18 with serious and persistent mental illness. Nestled between Ridgecrest and Centennial golf courses along the I-84 corridor, SHW provides evidence-based inpatient psychiatric treatment in a serene setting. We work closely with families and communities to help our clients return successfully to community living.

Additional Requirements: CPR and Nonviolent Crisis Intervention certification required (training provided) Availability to work weekends, holidays, and day shifts as needed.

This position is not eligible for telework.

The Idaho Department of Health & Welfare is a drug-free workplace. Any applicant offered employment in this position at the Idaho Department of Health and Welfare will be required to pass a pre-employment drug test. In addition, successful candidates will be required to complete a criminal history background investigation. Employment is dependent upon satisfactory results of the investigation.

BENEFITS:

The State of Idaho offers a robust total compensation and benefits package, including but not limited to:

We have one of the Nation's best state retirement systems (https://www.persi.idaho.gov/members-1/) (PERSI) that offers a lifetime benefit at retirement.

+ 11 paid holidays

+ Paid sick and vacation that begins accruing on your first day of employment; can be used immediately after accruing (no waiting time)

+ Paid parental leave (https://dhr.idaho.gov/information-for-state-employees/)

+ Medical, vision, and dental insurance benefits that become effective first of the month following your hire date. All contributions can be pre-tax (full-time/30+ hours per week)

+ 2 voluntary supplemental retirement plans including both pre-tax and Roth options

+ Deferred compensation plan

+ Life insurance for self, spouse, and children

+ Short and long-term disability insurance

+ Flexible Spending Accounts (FSA)

+ Wide variety of training opportunities

+ Some positions offer flexible hours and/or telecommuting

+ Additional perks and discounts (https://www.regence.com/producer/tools-for-members/advantages-discounts) available through medical provider

+ Public Service Loan Forgiveness (PSLF) Eligibility (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)

+ Employee assistance program

Additional information related to benefits and/or State programs can be found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.*

EXAMPLE OF DUTIES:

+ Coordinate Utilization Review Services to assess medical necessity, level of care, and appropriate treatment settings for patients.

+ Conduct concurrent and retrospective reviews of patient care, manage appeals, and facilitate communication with Managed Care Organizations regarding denials and authorizations.

+ Monitor resource utilization and report underuse, overuse, or inefficiencies to hospital leadership.

+ Communicate with third-party payers to secure reimbursement and support claims processing through documentation and coordination.

+ Collaborate with leadership to evaluate and enhance the Utilization Management Program, ensuring quality care and regulatory compliance.

+ Engage with treatment teams and external review bodies to support case management and optimize third-party reimbursement.

+ Develop and implement utilization policies and procedures using performance improvement tools and established standards.

+ Provide training and education to staff on licensure, Joint Commission, and CMS requirements, support staff development and onboarding.

+ Conduct compliance audits and performance reviews, contributing to data analysis and quality improvement initiatives.

+ Support continuous improvement efforts by analyzing outcomes, gathering feedback, and recommending operational enhancements

MINIMUM QUALIFICATIONS:

You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum qualifications for this position. Failure to do this may disqualify you from being considered for this position.

+ Licensed as a Professional or Registered Nurse in Idaho as defined by Idaho Code 54-1408 or state licensure as a Registered Nurse pursuant to the Nurse Licensure Compact, Idaho Code 54-1418. For licensure information, please contact the Idaho Board of Nursing at http://ibn.idaho.gov or call (208) 577-2476.

+ Experience performing nursing assessments and developing and implementing nursing care plans. Typically gained by at least six months work experience.

Below is preferred experience. It is not required for the position but applicants with this experience may receive consideration over other applicants.The below qualifications are typically gained by at least two years of work in healthcare administration, quality improvement, nursing leadership, or a related field, or through a combination of relevant education and practical experience.

+ Developing, recommending, and evaluating operating procedures and recommending changes.

+ Developing technical written materials such as policies, technical manuals, or rules/regulations.

+ Ability to interpret and report out data.

***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 4:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

Email is the quickest way to get an answer to your questions.

(answered Monday through Friday during business hours MST)

EMAIL: [email protected]

PHONE: (208) 334-0681

EEO/ADA/Veteran:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email[email protected].

Preference may be given to veterans who qualify under state and federal laws and regulations.