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Insurance Utilization Reviewer Jobs in Idaho (NOW HIRING)

Trinity Health

Clinical Resource Manager

Boise, ID · On-site

$61K - $85K/yr

Provides hospital case management/utilization review and discharge planning collaboratively ... Experience in case management, home health, and/or the insurance industry preferred. WHAT YOU WILL ...

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Insurance Utilization Reviewer information

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Idaho? For Insurance Utilization Reviewer jobs in Idaho, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Idaho look for? The top searched job categories for Insurance Utilization Reviewer jobs in Idaho are:
What cities in Idaho are hiring for Insurance Utilization Reviewer jobs? Cities in Idaho with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Idaho as of July 2026, with employment types broken down into 2% As Needed, 90% Full Time, 4% Part Time, 2% Temporary, and 2% Contract. Highlights an 91% In-person, and 9% Remote job distribution.

UTILIZATION REVIEW COORDINATOR

MOUNTAIN VIEW HOSPITAL LLC

Idaho Falls, ID • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 6 days ago

Mountain View Hospital (Idaho Falls) rating

5.2

Company rating: 5.2 out of 10

Based on 59 frontline employees who took The Breakroom Quiz

969th of 1,054 rated hospitals

Job description

Mountain View Hospital is looking for a Utilization Review Coordinator to join our team!

JOB SUMMARY: As a member of the Utilization Management Team, the UR
Coordinator helps establish and maintain efficient methods of ensuring the medical necessity and appropriateness of hospital admissions and extended stays. The Utilization Management Team directs the program in accordance with Mountain View Hospital’s mission and strategic goals. The Utilization Management Team directs those activities within the facility which monitor adherence to the hospital’s utilization review plan. The goal of Utilization Management is to continuously improve effective use of hospital services through monitoring patient admissions and stays.

About Mountain View:

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

BENEFITS:

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

  • Medical, Dental and Vision Insurance
  • Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
  • Retirement Plans (401K with up to 6% match)
  • Earned Quarterly Bonus Program
  • Education Reimbursement Program
  • Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

Education/Certification: High School Diploma or equivalent. Coding certificate completion is required within 1 year of employment

Experience: Background in medical terminology is helpful. Medical coding and/or insurance experience preferred, however coding certification will be required with in one calendar year of employment

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