- Molina Healthcare (Nampa, ID)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...nursing experience, including at least 1 year of utilization review , medical claims review… more
- Humana (Boise, ID)
- …interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure ... caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure...clinical and coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Highmark Health (Boise, ID)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Molina Healthcare (ID)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
- CVS Health (Boise, ID)
- …+ Explains member's rights and responsibilities in accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints ... in preparation of complaint trend reports. Assists in compiling claim data for customer audits. + Determines medical...requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member … more
- Molina Healthcare (ID)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …medical staff as appropriate. He or she may supervise and mentor students, medical students and residents, nurse practitioners, and . The incumbent expected ... and management of patients with pulmonary disease and sleep disorders teaching medical students and supervising residents, fellows, and nurse practitioners. This… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- … medical staff as appropriate. May supervise and mentor students, medical students and residents, nurse practitioners, and others. Additional Requirement: ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...restriction on moonlighting This position is located within the Medical Service of the Boise VA Medical … more
- Elevance Health (Meridian, ID)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more