• RN , Manager , Utilization…

    Humana (Boise, ID)
    **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
    Humana (09/28/25)
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  • Clinical Learning Facilitator - Utilization…

    Molina Healthcare (Idaho Falls, ID)
    … RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
    Molina Healthcare (09/17/25)
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  • Case Manager , Registered…

    CVS Health (ID)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
    CVS Health (10/02/25)
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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (Meridian, ID)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (09/06/25)
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  • Care Manager (UM/UR) - Remote, Idaho…

    Magellan Health Services (Boise, ID)
    …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... an active work load in accordance with National Care Manager performance standards. + Works with community agencies as...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
    Magellan Health Services (07/26/25)
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  • Clinical Manager , Behavioral Health (UM)…

    Magellan Health Services (Boise, ID)
    …Professional Counselor - Care MgmtCare Mgmt, PC - Professional Counselor - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - ... , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management ...required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN . If RN , BSN preferred but ASN… more
    Magellan Health Services (08/26/25)
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  • Disease Management Nurse - Remote

    Sharecare (Boise, ID)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager ...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
    Sharecare (09/13/25)
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  • Clinical Resource Manager Part-Time Days

    Trinity Health (Boise, ID)
    …Shift **Description:** **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management / utilization review and discharge planning collaboratively determining ... care as appropriate. Coordinates the hospital activities concerned with case management / utilization review and discharge planning. Adheres to departmental goals,… more
    Trinity Health (10/01/25)
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  • Infusion Referral Nurse - REMOTE

    Prime Therapeutics (Boise, ID)
    …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing… more
    Prime Therapeutics (10/04/25)
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  • Director, Clinical Systems

    Molina Healthcare (Meridian, ID)
    …skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and ... including design, development, implementation, and oversight of technology that drives core utilization management , care management , long-term services and… more
    Molina Healthcare (10/01/25)
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