Nurse Manager, Utilization Review
Trinity Health
full-time
Posted on:
Location Type: Hybrid
Location: Boise • Idaho • United States
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About the role
- Oversee daily utilization review operations, serving as first point of escalation for issue resolution.
- Ensure compliance with payer and regulatory requirements.
- Provide supervisory leadership through scheduling, performance management, and guiding staff development.
- Direct utilization review workflows and medical necessity evaluations.
- Manage denial prevention, expedited appeals, and payer communication to secure authorizations.
- Collaborate closely with Physician Advisors, CRM Managers, and the multidisciplinary team to maintain reporting and optimize departmental processes.
Requirements
- 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 utilization review or case management or similar required.
- 2 or more years of supervisory experience required.
- American Heart Association Basic Life Support for HealthCare Provider (BLS/HCP) certification required
Benefits
- Day 1 Benefits – colleagues are eligible for our plans from their very first day of work.
- Market-competitive pay
- Generous PTO
- Retirement planning and matching
- College savings plans for your family
- Multiple life insurance plans
- Employee Assistance Programs
- Tuition reimbursement
- Educational opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization reviewcase managementmedical necessity evaluationsdenial preventionexpedited appealspayer communicationperformance managementstaff development
Soft Skills
supervisory leadershipissue resolutioncollaborationguiding staff development
Certifications
Registered NurseBSNBasic Life Support for HealthCare Provider (BLS/HCP)