Trinity Health · 1 day ago
Utilization Review Manager FT Days
Boise, ID
Full-time
Onsite
Senior Level
5+ years expTrinity Health, through Saint Alphonsus, is seeking a Utilization Review Manager to lead the Utilization Review Team in Boise, Idaho. This role is responsible for overseeing daily utilization review operations, ensuring compliance with payer and regulatory requirements, and providing supervisory leadership to the team.
DeliveryHealth Care
Responsibilities
Performs coaching/feedback, completes timely evaluations, and resolves staff conflict
Excellent communication skills and ability to form working relationships with third party payors and physicians
Lead all cause readmission prevention programs
Maintains appropriate staffing/scheduling to support utilization management process and functions
Maintains accurate and up-to-date employee files consistent with organizational policies/practices
Help ensure organizational commitment to patient satisfaction. Reacts in a timely manner to resolve patient complaints and promotes customer service standards among staff
Help ensure effective cost/expense management
Excellent organization and documentation skills
Assists Manager with staff meetings on a regular basis
Attends and participates in off-site meetings and/or seminars
Ensures compliance with policies and procedures (organizational, insurance, etc.). Helps ensure compliance with OSHA, CLIA, and State radiological safety standards as well as any other local, state, or federal mandates
Demonstrates ability to work independently and take initiative
Demonstrates knowledge and skills to competently care for all assigned age groups (Neonate, Child, Adolescent, Adult, and Geriatric as applicable)
Research all possible payors by contacting the Insurance Verification Dept. and other resources to verify patients’ eligibility
Assists the Manager in hiring, training, coaching, and evaluating personnel and directs the clinical supervision of the team either through individual or group supervision or through formal case consultations
When necessary, conduct in-person assessment interview with potential and new patients and /or their families to determine financial resources and insurance coverage
Reviews necessary medical records, relaying clinical information to payors and documenting authorization
Obtains authorization from insurance companies, documents result and notifies appropriate staff
Interacts with health care providers to identify medical necessities and appropriateness of admission to the inpatient setting and provides feedback to staff on appropriate documentation to support the need for admission
Responds to patient and patient's family by answering their questions regarding the patient's ongoing benefits during his/her inpatient treatment
Assists Assessment and Referral Department in determining coverage issues that may affect patient's decisions to voluntarily admit to this facility
Maintains a strong relationship with insurance payers to facilitate discussions regarding authorization approvals
Assists in obtaining insurance authorization when clinical information is required
Serve as a liaison between the hospital and external payers on issues related to severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services
Responsible for managing inpatient appeals by compiling and submitting responses to insurance payors with the intent of overturning denial and improving reimbursement outcomes
Initiates and presents "denial letters" as appropriate
Stays abreast of new regulatory laws that affect reimbursement of inpatient and outpatient services
Provides in-service training to clinical staff on the charting requirements needed for reimbursement
Qualification
Required
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 case management required
2 or more years of supervisory experience required
American Heart Association Basic Life Support for HealthCare Provider (BLS/HCP) certification required
Preferred
7 or more years of experience in case management preferred
Benefits
Market-competitive pay
Generous PTO
Multiple options for comprehensive benefits that begin on day one
Retirement planning and matching
College savings plans for your family
Multiple life insurance plans that can change as your needs develop
Employee Assistance Programs
Tuition reimbursement
Educational opportunities to help you learn and grow
Company
Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.02MKey Investors
Centers for Disease Control and Prevention
2025-10-17Grant· $0.02M
Leadership Team
Dan Drake
Trinity Health PACE President and CEO
Eileen Coogan
Pres/CEO Allegany Franciscan Ministries
Recent News
2026-01-16
Company data provided by crunchbase