• Clinical Appeals Nurse

    R1 RCM (Boise, ID)
    …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
    R1 RCM (05/20/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Meridian, ID)
    …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions… more
    Molina Healthcare (05/16/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Boise, ID)
    …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... and client policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, and a… more
    Evolent (05/16/25)
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  • Appeals Nurse

    Evolent (Boise, ID)
    …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
    Evolent (05/10/25)
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  • Clinical Appeals Supervisor

    R1 RCM (Boise, ID)
    …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
    R1 RCM (04/18/25)
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  • Medical Director Specialty Medical Services…

    Molina Healthcare (Caldwell, ID)
    …Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to the enterprise. Primary responsibilities will include ... specialized medical necessity reviews and/or appeals and supporting market performance. Performance activities include physician auditing, training, and performance… more
    Molina Healthcare (04/09/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Idaho Falls, ID)
    …state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (05/02/25)
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  • Family Health Advocate - Remote

    Sharecare (Boise, ID)
    …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical,… more
    Sharecare (04/12/25)
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