RN Utilization & Clinical Review - Swing Shift

St Luke; Boise (ID); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Fully Benefited

Sign-on bonus eligible

Job summary

St. Luke’s is seeking a Clinical Review Nurse to evaluate medical necessity for admissions and ongoing hospital stays. The role focuses on applying clinical criteria and coordinating with care teams to ensure appropriate utilization of services.

The position offers intensive training, a swing shift from 3–11 PM, and a fully benefitted package with sign-on bonus eligibility. Idaho RN licensure is required, with 3–5 years of relevant experience depending on degree.

Qualifications

• RN license in Idaho is required.
• 3 years RN/utilization management with BSN or 5 years with ASN.
• Knowledge of medical necessity criteria and regulatory requirements.

Responsibilities

• Review the medical necessity of admission, continued hospitalization, length of stay, and potential denial of payment issues.
• Provide feedback to the healthcare team regarding resource use and plan of care.
• Communicate results of reviews to primary care teams, specialty providers, vendors, and members in compliance with requirements.

Skills

Utilization management

RN experience

Medicare/Medicaid review

Education

Bachelor of Nursing

Associates of Nursing Degree

Job description

St. Luke’s is seeking a Clinical Review Nurse to evaluate medical necessity for admissions and ongoing hospital stays. The role focuses on applying clinical criteria and coordinating with care teams to ensure appropriate utilization of services.

The position offers intensive training, a swing shift from 3–11 PM, and a fully benefitted package with sign-on bonus eligibility. Idaho RN licensure is required, with 3–5 years of relevant experience depending on degree.