Utilization Management Nurse - St. Luke's Health Plan

St Luke; Boise (ID); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Fully benefitted

Hybrid work schedule

Job summary

St. Luke’s Health Plan seeks an RN reviewer to assess medical necessity for procedures and preauthorizations. This fully benefitted role offers a hybrid schedule (3 days remote, 2 on-site) and a Monday–Friday 8:00–4:30 with one Saturday per year.

Required BSN or ASN with Idaho RN licensure and 3–5 years of relevant experience; Medicare Advantage familiarity preferred. Join a mission-driven team focused on quality and cost-effective care.

Qualifications

• RN licensure Idaho required.
• BSN or ASN degree required.
• UM experience and Medicare Advantage plan preferred.

Responsibilities

• Review and assess requests for medical procedures, treatments, and inpatient admissions to ensure medical necessity criteria.
• Timely and accurate review of preauthorization requests to facilitate appropriate care while managing costs.

Skills

RN licensure Idaho

Education

BSN

ASN

Job description

At St. Luke’s Health Plan, we’re on a mission to connect people with affordable, hassle-free health care. We are the only health plan in Idaho putting doctors and insurance on the same team to deliver a more efficient and quality health care experience with less stress. Join us in this bold ambitious journey. We’d love to hear from you!

St. Luke’s Health Plan is a wholly-owned, not-for-profit subsidiary of St. Luke’s Health System, offering health insurance coverage for individuals, families and employers across south central and southwestern Idaho. Building on more than 120 years of committed service to Idaho, St. Luke’s Health Plan is on a bold and ambitious mission to redefine the coverage to care experience, removing barriers for both members and providers and creating a more seamless, hassle-free experience.

What You Can Expect:

• Responsible for reviewing and assessing requests for medical procedures, treatments, services, and inpatient admissions to ensure they meet medical necessity criteria
• Timely and accurate review of preauthorization requests, facilitating the best possible care for St. Luke's Health Plan members while managing healthcare costs
• Fully benefitted position with hospital contributions
• Hybrid Work Schedule-3 days at home, 2 days on site
• Monday-Friday 8-4:30
• One Saturday coverage per year

Qualifications:

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

UM experience and Medicare Advantage plan preferred

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.