Top 13 Clinical documentation & utilization review nurses Jobs in Idaho

Quality Clinical Reviewer (Idaho license) - Remote
Magellan Health —Boise, ID
- $70,715 - $113,145 a year
- Full-time
- Remote
- LMFT
- Nursing
- RN License
7d
Utilization Management Registered Nurse
Humana —Idaho
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Quality Practice Liaison (Must be licensed in Arizona or Multi-State)
CVS Health —Idaho
- $54,095 - $155,538 a year
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
12d
Clinical Appeals Coordinator
Trillium Community Health Plan —Idaho
- $33.71 - $60.67 an hour
- Full-time
- Remote
- Nursing
- LVN
- RN License
- Paid holidays
- Health insurance
3d
Denials Management Specialist
Pennant Services, Inc. —Eagle, ID
- Full-time
- Nursing
- Microsoft Excel
- RN License
Quick Apply
11d
Swing Shift RN Clinical Review Management
St. Luke's Health System —Boise, ID
- 8 hour shift
- Nursing
- RN License
- Mid-level
- Paid training
Quick Apply
11d
Clinical Quality Specialist | SQM | Full Time (On-Site)
Gritman Medical Center Inc. —Moscow, ID
- Full-time
- Nursing
- RN License
- Hospital
Quick Apply
MDS Coordinator
Orchard View Post Acute —Lewiston, ID
- $32 - $55 an hour
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
Quick Apply
Assistant Director of Nursing/MDS
Lincoln County Care Center —Shoshone, ID
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health savings account
- Health insurance
Quick Apply
12d
MDS Nurse
Karcher Post Acute —Nampa, ID
- $35 - $45 an hour
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
Quick Apply
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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Utilization Management Registered Nurse
Humana —Idaho
Must hold Compact Registered Nurse (RN) license in your state of residence. BSN or bachelor's degree in a related field. (i.e. 10 reviews per day?).
$71,100 - $97,800 a year
Director of Surgical Services
Steele Memorial Medical Center —Salmon, ID
RN licensure required in the state of Idaho; BSN preferred. Current BLS and ACLS certification required. Provides technical consultation and support to Surgical…
Quick Apply

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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
MDS Coordinator/RN - Full-time - Weekdays
Willow Brook Home —Columbus, OH
Active RN license in Ohio. RN (or LPN) license in good standing (Required). Willow Brook Home is seeking a full-time MDS Coordinator to support our 50-bed care…
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Quality Clinical Reviewer (Idaho license) - Remote

Magellan Health -
Boise, ID

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Job Details

Full-time
$70,715 - $113,145 a year
7 days ago

Qualifications

Managing projects

Full Job Description

This is a remote position and will require the Idaho independent BH or RN licensure. If you reside outside of Idaho, you will also need to be licensed in the State you reside.

Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.

Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
Reviews provider treatment records against clinical and procedural established standards.
Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
Conducts reviews of Quality of Care and Critical/Adverse Incidents.
Evaluates level of patient safety risk and need for follow-up actions per policies.
Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
Prepares monthly performance reports with assistance from Reporting and Analytics unit. Presents findings at provider and customer meetings as needed.
Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
Responsible for auditing as well as validating internal audit results and/or corrective action plans.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities

Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.
5+ years of clinical experience required.
Will substitute 7 or more years of clinical experience along with an associate's degree and RN licensure in place of the bachelor's degree and RN licensure.
Experience working with total quality improvement or a behavioral healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.
Ability to work independently with minimal supervision.
Project management skills and demonstrated experience.

General Job Information

Title

Quality Clinical Reviewer (Idaho license) - Remote

Grade

Work Experience - Required

Clinical

Work Experience - Preferred

Quality

Education - Required

Bachelor's - Nursing, Master's - Behavioral Health

Education - Preferred

PsyD - Clinical Psychology

License and Certifications - Required

LCSW - Licensed Clinical Social Worker - Care MgmtCare MgmtCare Mgmt, LMHC - Licensed Mental Health Counselor - Care MgmtCare MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare MgmtCare Mgmt, MFT - Marriage and Family Therapist - Care MgmtCare MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare MgmtCare Mgmt

License and Certifications - Preferred

Salary Range

Salary Minimum:

$70,715

Salary Maximum:

$113,145

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

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Refine Your Search

clinical documentation & utilization review nurses jobs in idaho

Quality Clinical Reviewer (Idaho license) - Remote

Utilization Management Registered Nurse

Quality Practice Liaison (Must be licensed in Arizona or Multi-State)

Clinical Appeals Coordinator

Denials Management Specialist

Swing Shift RN Clinical Review Management

Clinical Quality Specialist | SQM | Full Time (On-Site)

MDS Coordinator

Assistant Director of Nursing/MDS

MDS Nurse

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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