RN Clinical Utilization Reviewer (Evenings)

St. Luke's Health System; Boise (ID); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Sign On Bonus Eligible

Fully Benefitted

Job summary

St. Luke’s Health System in Meridian, Idaho, seeks a Clinical Review Nurse to evaluate medical necessity for admissions and ongoing patient care. You will apply clinical criteria, review utilization, and communicate findings to care teams both on-site and with providers.

We offer intensive paid training, a full benefits package, and a sign-on bonus eligible opportunity. Join a supportive team focused on delivering exceptional patient experiences and strong resource stewardship.

Qualifications

• Bachelor of Nursing or Associate Degree in Nursing.
• 3 years RN or utilization management experience (BSN) or 5 years (ASN).
• Current Idaho RN license.

Responsibilities

• Reviews the medical necessity of admission, continued hospitalization, length of stay, and any potential denial of payment issues.
• Applies established criteria using clinical expertise to determine medical necessity of services.
• Communicates results of reviews to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements.
• Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and timely follow-through with the plan of care.

Skills

Clinical review

Utilization management

Regulatory compliance

Team communication

Education

Bachelor of Nursing or Associate's Degree in Nursing

Job description

St. Luke’s Health System in Meridian, Idaho, seeks a Clinical Review Nurse to evaluate medical necessity for admissions and ongoing patient care. You will apply clinical criteria, review utilization, and communicate findings to care teams both on-site and with providers.

We offer intensive paid training, a full benefits package, and a sign-on bonus eligible opportunity. Join a supportive team focused on delivering exceptional patient experiences and strong resource stewardship.