Top 73 Utilization management Jobs in Boise, Id

Case Management Nurse - Oncology or Transplant Experience
Innovative Care Management, Inc. —Idaho
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
6d
Remote Care Management Nurse
Cambia Health Solutions —Idaho
- $38.00 - $41.50 an hour
- Overtime
- Remote
- Background check
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Clinical Resource Manager Case Manager
Saint Alphonsus Health System —Boise, ID
- Part-time
- Acute care
- Nursing
- RN License
Quick Apply
12d
Clinical Resource Manager
Saint Alphonsus Health System —Boise, ID
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
Case Management Assistant Part Time
St. Luke's Health System —Meridian, ID
- Part-time
- Mid-level
- Experience equivalent to degree accepted
- Associate's degree
Quick Apply
4d
Field Care Coordinator - Remote in Ada County, ID and Surrounding Areas
UnitedHealthcare —Boise, ID
- $29 - $52 an hour
- Full-time
- LMFT
- Spanish
- Microsoft Outlook
5d
Senior Director, Utilization and Case Management
St. Luke's Health System —Boise, ID
- Full-time
- Acute care
- Hospital
- Master's degree
Quick Apply
Manager, Inpatient and Post Acute Services
PacificSource Health Plans —Boise, ID
- $91,587.15 - $160,277.52 a year
- Full-time
- Nursing
- RN License
- Licensed Clinical Social Worker
4d
Virtual Reimbursement Manager
Syneos Health Commercial Solutions —Boise, ID
- Mid-level
- Bachelor's degree
- In-person
- Health insurance
- Dental insurance
Senior Registered Nurse (RN) - MED
State of Idaho —Boise, ID
- $33.61 - $34.62 an hour
- Weekends as needed
- Nursing
- RN License
- Customer service
- Paid parental leave
- Paid holidays
5d
CCM Specialist (RN)
Pennant Services, Inc. —Eagle, ID
- Full-time
- Remote
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
13d
Specialty Care Financial Navigator
Saint Alphonsus —Boise, ID
- Full-time
- RN License
- Mid-level
- Microsoft Office
- Tuition reimbursement
- Employee assistance program
Remote Triage Nurse
firsthand Health —Boise, ID
- $80,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Bachelor of Science
- Dental insurance
- Parental leave
Quick Apply
Clinical Resource Manager
Saint Alphonsus —Boise, ID
- Full-time
- Nursing
- RN License
- Hospital
Virtual Reimbursement Manager
サイネオス・ヘルス —Boise, ID
- Mid-level
- Bachelor's degree
- In-person
- Health insurance
- Dental insurance
Clinical Resource Manager Case Manager
Saint Alphonsus —Boise, ID
- Part-time
- Acute care
- Nursing
- RN License
Pharmacy Technician II
PacificSource Health Plans —Boise, ID
- $39,807.95 - $63,692.71 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Writing skills
4d
RN Case Manager
West Valley Medical Center —Caldwell, ID
- $38.40 - $57.60 an hour
- Part-time
- Mid-level
- 2 years
- Employee stock purchase plan
- Disability insurance
Quick Apply
Orderly Supervisor
St. Luke's Health System —Boise, ID
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
Quick Apply
6d
Medical Case Manager I
CorVel Corporation —Boise, ID
- $62,306 - $93,123 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply

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utilization management jobs near boise, id

Case Management Nurse - Oncology or Transplant Experience

Innovative Care Management, Inc.
Idaho

Apply Now

Job Details

Full-time
6 days ago

Benefits

Health insurance

Qualifications

Care plan evaluation
Nursing
RN License
Maintaining patient confidentiality
Working with individuals with chronic illnesses
HIPAA
Patient advocacy
Case management
Utilization management
Bachelor of Science in Nursing
Resource utilization in healthcare
Health information regulatory compliance
Disease state management
Transplant care
Oncology
Associate Degree in Nursing

Full Job Description

About Innovative Care Management

In an increasingly complex healthcare environment, ICM remains focused on something essential: putting people at the center of every decision. We are dedicated to ensuring that members and health plans feel genuinely seen, heard, and supported throughout their care journey.

We serve clients nationwide with a values-driven approach that blends compassion, clinical expertise, and operational excellence. Our core values: Kindness, Personal Responsibility, a Can-Do Attitude, and Humble Confidence, shape how we work, how we lead, and how we care for those we serve.

As we grow, we welcome individuals who share our belief that healthcare should be effective, compassionate, and truly centered on people.

About The Role

The Case Manager Nurse plays a critical role in supporting members with complex medical conditions by providing proactive, telephonic case management grounded in a whole-person approach. This position will primarily support members with oncology and transplant-related needs, helping patients navigate some of the most complex healthcare journeys while improving care coordination, outcomes, and the overall member experience.

As a trusted clinical resource, you'll partner closely with members, providers, transplant centers, oncology teams, and health plans to assess needs, develop individualized care plans, and advocate for appropriate, cost-effective services. In addition to case management responsibilities, you'll also support utilization review activities when needed, contributing to timely medical necessity determinations and continuity of care.

This position is ideal for an experienced RN with a background in oncology and transplant nursing who brings strong clinical judgment, exceptional communication skills, and a passion for supporting patients through complex episodes of care in a collaborative, remote environment.

This is a fully remote role. Candidates must reside in Iowa, Arizona, or Idaho.

Schedule: This position works four 10-hour shifts per week and must be able to support ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time. Specific shift times may vary based on business needs and the candidate’s time zone. For example, a candidate residing in Iowa may have a shift that begins earlier in Central Time, such as 7:00 AM or 8:00 AM CT, depending on coverage needs.

What You'll Do

Patient Identification & Assessment

Identify members who would benefit from case management using claims data, referrals, and clinical records
Review referrals for clinical appropriateness using sound judgment and program parameters
Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach

Care Planning & Coordination

Develop individualized care plans based on patient needs, barriers, and goals
Coordinate care across the continuum, including primary care, oncology providers, transplant teams, specialists, behavioral health, and community-based resources
Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans

Clinical Case Management & Advocacy

Provide telephonic case management for high-utilization patients with complex or chronic conditions
Use best practices in chronic disease management, motivational interviewing, and patient education
Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines
Support patients in navigating healthcare systems and overcoming barriers to care

Utilization Review & Medical Decision-Making

Evaluate precertification requests using evidence-based criteria and plan-specific guidelines
Review ongoing inpatient stays and make length-of-stay determinations as appropriate
Partner with Appeals & Denials and/or in-house providers to support complex clinical decisions

Documentation, Reporting & Compliance

Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems
Provide client-facing reports summarizing interventions, outcomes, and estimated cost savings
Ensure compliance with internal policies, regulatory requirements, and HIPAA standards

Collaboration, Leadership & Continuous Improvement

Partner with other clinical teams across ICM to remove care barriers and improve patient outcomes
Serve as a senior clinical resource, contributing to program development, cross-training, and process improvement
Stay current on best practices, regulations, and clinical guidelines related to case management
Participate in training, quality assurance initiatives, and professional development

What You Bring

Required

Active, unrestricted Registered Nurse (RN) license in good standing
Associate’s or Bachelor’s degree in Nursing
5+ years of clinical nursing experience
Current or recent oncology nursing experience
Current or recent transplant nursing experience (solid organ, living donor, HSCT/BMT, or tissue transplant)
Strong knowledge of chronic disease management, utilization management, and social determinants of health
Experience managing complex, high-utilization patient populations
Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence
Strong organizational skills with the ability to manage multiple priorities independently
Sound clinical judgment and confidence navigating complex or sensitive situations
Comfort working independently in a remote environment with strong accountability and follow-through
Ability to manage confidential information in compliance with HIPAA
Must reside in Iowa, Arizona, or Idaho
Ability to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time

Even Better If You Have

Case management or utilization certifications (e.g., CCM, CPUR, CPHM)
Certified Clinical Transplant Nurse (CCTN) credential
Certification through the American Association of Transplant Management (AATM)
Oncology Certified Nurse certification (OCN).
Experience in case management

Experience in a TPA or self-funded health plan environment
Knowledge of health insurance regulations and utilization management processes
Experience using medical necessity criteria and utilization review tools
Experience with EMRs and care management platforms
Multi-state licensure

Work Location: Remote

Apply Now

Refine Your Search

utilization management jobs in boise, id

Case Management Nurse - Oncology or Transplant Experience

Remote Care Management Nurse

Clinical Resource Manager Case Manager

Clinical Resource Manager

Case Management Assistant Part Time

Field Care Coordinator - Remote in Ada County, ID and Surrounding Areas

Senior Director, Utilization and Case Management

Manager, Inpatient and Post Acute Services

Virtual Reimbursement Manager

Senior Registered Nurse (RN) - MED

CCM Specialist (RN)

Specialty Care Financial Navigator

Remote Triage Nurse

Clinical Resource Manager

Virtual Reimbursement Manager

Clinical Resource Manager Case Manager

Pharmacy Technician II

RN Case Manager

Orderly Supervisor

Medical Case Manager I

I want to receive the latest job alert for utilization management in boise, id

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