Swing Shift RN Clinical Review Management

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

Clinical Review Management System Office

Position Type

Full-Time

Shift

Swing

Job ID

157053

City

State

ID

Category

Nursing - Experienced

Description & Requirements

At St. Luke’s, our dedicated team of Clinical Review Nurses strive to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.

What You Can Expect:

• 8-hour shifts, 3-11 PM
• Intensive paid training
• Reviews the medical necessity of admission, continued hospitalization, length of stay, and any potential denial of payment issues. Applies established criteria and employs clinical expertise to interpret clinical criteria to determine medical necessity of services. Performs Medicaid and Medicare review.
• 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. Communicates results of reviews to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements.
• Fully Benefitted
• Sign On Bonus Eligible

Qualifications:

• Education: Bachelor of Nursing or Associates of Nursing Degree
• Experience: 3 years of RN or utilization management experience (BSN) or 5 years of RN or utilization management experience (ASN)
• Licenses/Certifications: Current RN license in Idaho

For more information, contact Julie at [e-mail]

What's In It For You

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.