Utilization Review Manager overseeing daily review operations and compliance at Saint Alphonsus in Boise, Idaho. Providing supervisory leadership and collaborating with medical teams for optimal outcomes.
Responsibilities
Oversee daily utilization review operations, serving as first point of escalation for issue resolution.
Ensure compliance with payer and regulatory requirements.
Provide supervisory leadership through scheduling, performance management, and guiding staff development.
Direct utilization review workflows and medical necessity evaluations.
Manage denial prevention, expedited appeals, and payer communication to secure authorizations.
Collaborate closely with Physician Advisors, CRM Managers, and the multidisciplinary team to maintain reporting and optimize departmental processes.
Requirements
Licensed in the State of Idaho as a Registered Nurse as defined by the Idaho State Board of Nursing.
BSN required
5 or more years of experience in utilization review or case management or similar required.
2 or more years of supervisory experience required.
American Heart Association Basic Life Support for HealthCare Provider (BLS/HCP) certification required
Benefits
Day 1 Benefits – colleagues are eligible for our plans from their very first day of work.
Assistant Traffic Manager supporting marketing and digital campaigns for Undiz. Responsible for advertising and performance analysis with various channels.
Revenue Cycle Systems Manager overseeing operational health of RCS billing systems for a healthcare leader. Managing teams, incidents, and ensuring compliance in a regulated environment.
Business Planning Manager at ASUS overseeing financial governance and business operations in Fremont, California. Leading performance tracking, process improvement initiatives, and spend control frameworks.
Delivery Manager leading data projects for a fast - growing tech start - up. Focused on driving delivery excellence and managing complex data solution projects.
Clinical Services Manager responsible for supervising operations and patient care in a medical clinic. Ensures quality assurance and operational efficiency within the clinic unit.
Regional Quality Manager responsible for quality management and continuous improvement across Western Europe & Israel. Collaborating with cross - border stakeholders and supporting local teams in quality standards.
Senior Claims Manager managing workers compensation claims in New Zealand. Seeking experienced claims professionals to coordinate worker recovery and collaborate with stakeholders.
Brand and Customer Manager responsible for marketing strategy in Oncology and Vaccines across CIS markets. Aiming to expand commercial reach and engage customers effectively.