Nurse Manager Utilization Review - Hybrid

Overview

Position Summary and Highlights: Saint Alphonsus is hiring a Utilization Review Manager to lead the Utilization Review Team in Boise, Idaho.

Employment Type Full time

Shift Day Shift

• Oversee daily utilization review operations and act as the first point of escalation for problem-solving, ensuring compliance with payer and regulatory requirements.
• Provide supervisory leadership, including scheduling, coaching, performance management, and staff development support.
• Lead readmission prevention programs, denial management workflows, and securing insurance authorizations through clinical reviews and active payer communication.
• Collaborate with Physician Advisors and leadership to optimize processes, maintain data reporting, and support organizational goals.
• Maintain strong communication with third-party payors and physicians.
• Ensure compliance with policies and procedures, OSHA, CLIA, and state radiological safety standards, and other local, state, or federal mandates.
• Demonstrate ability to work independently and take initiative; care for all assigned age groups as applicable.
• Support hiring, training, coaching, and evaluating personnel; supervise the team through individual or group supervision or formal case consultations.
• Assist in obtaining and documenting insurance authorizations and communicating results to appropriate staff.
• Interact with healthcare providers to identify medical necessity and the appropriateness of inpatient admission; provide guidance on documentation to support admission decisions.
• Respond to patient and family inquiries regarding ongoing benefits during inpatient treatment.
• Maintain relationships with insurance payers to facilitate authorization discussions and appeals; manage inpatient appeals by compiling and submitting responses to overturn denials when possible.
• Stay current on regulatory changes affecting reimbursement for inpatient and outpatient services; provide in-service training on charting requirements needed for reimbursement.

• 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 case management required; 7+ years preferred.
• 2 or more years of supervisory experience required.
• American Heart Association Basic Life Support for Health Care Provider (BLS/HCP) certification required.

• Award-Winning Culture – Saint Alphonsus Health System recognized as one of America’s Best Large Employers by Forbes.
• Day 1 Benefits – plans available from the first day of work.

• Market-competitive pay, generous PTO, and multiple benefits starting on day one.
• Retirement planning and matching, college savings plans, and life insurance options that can evolve with needs.
• Employee Assistance Programs, tuition reimbursement, and opportunities for professional growth.

Saint Alphonsus Health System is a faith-based, not-for-profit system serving Idaho, Oregon, and northern Nevada with multiple facilities and clinics. Our focus is patient-centered, physician-led, innovative, and community-based care.

• Top 15 Health Systems in the country by IBM Watson Health;
  Level II Trauma Center;
  Commission on Cancer Accredited Program.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.