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Insurance Utilization Reviewer Jobs in Idaho (NOW HIRING)

The Walker Center

Outpatient Counselor

Twin Falls, ID · On-site

$29/hr

Completes timely utilization reviews and insurance reviews (or communicates needs to supervisor or treatment team). * Completes individual, group, and family counseling sessions which address the ...

Amazon

Staff Pharmacist, Amazon Pharmacy

Nampa, ID · On-site

$57 - $67/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... DUR (Drug Utilization Review) and ensure accurate documentation in pharmacy systems • Monitor ... Amazon also offers comprehensive benefits including health insurance (medical, dental, vision ...

Amazon

Overnight Staff Pharmacist, Amazon Pharmacy

Nampa, ID · On-site

$57 - $67/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... DUR (Drug Utilization Review) and ensure accurate documentation in pharmacy systems • Monitor ... Amazon also offers comprehensive benefits including health insurance (medical, dental, vision ...

EleMental Health

Office Manager

Boise, ID · On-site

Collect demographic, insurance, and required intake information. * Ensure all consent forms ... Review rejected claims and facilitate corrections. * Reconcile daily payments and deposits ...

EleMental Health

Office Manager

Boise, ID

Collect demographic, insurance, and required intake information. * Ensure all consent forms ... Review rejected claims and facilitate corrections. * Reconcile daily payments and deposits ...

Yoke's Fresh Market

Pharmacist

Post Falls, ID · On-site

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Yoke's Fresh Market

Pharmacist

Post Falls, ID · On-site

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Yokes Fresh Markets

PHARMACIST

Post Falls, ID · On-site

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Yoke's Fresh Market

Pharmacist

Post Falls, ID · On-site

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Yoke's Fresh Markets

Pharmacist

Post Falls, ID

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Yoke's Fresh Markets

Pharmacist

Post Falls, ID · On-site

$63.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

... drug utilization review and, answering questions on drug interaction, side effects, dosage and ... mothers, insurance billing, pet prescriptions, smoking cessation, special orders of OTC, and ...

Northpoint Recovery Holdings, LLC

Clinical Assessor

Meridian, ID · On-site

$34 - $45/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Work collaboratively with client's funding sources and Northpoint's Utilization Review team to ... Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s) * 100% Employer Paid ...

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Showing results 41-60

All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Idaho

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 is an insurance utilization reviewer?

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 August 2026, with employment types broken down into 2% As Needed, 87% Full Time, 7% Part Time, 2% Temporary, and 2% Contract. Highlights an 91% In-person, and 9% Remote job distribution.

Outpatient Counselor

Walker Center for Alcoholism and Drug Addiction

Twin Falls, ID • On-site

Full-time

Re-posted 16 hours ago

Job description

Description:
  • Completes client evaluation based on assessment of their needs and complete diagnosis based on DSM 5 criteria and level of care placement based on ASAM Criteria.
  • Completes individualized treatment planning with clients including initial, on-going, continuing care and discharge plan.
  • Completes referral and discharge planning with client and family, or oversees referral completion with the Discharge Planner, if available.
  • Completes timely utilization reviews and insurance reviews (or communicates needs to supervisor or treatment team).
  • Completes individual, group, and family counseling sessions which address the individual needs of the client, including relapse prevention.
  • Prepares and completes all necessary documentation and record keeping.
  • Prepares individualized daily notes, showing accurate and personalized documentation regarding the client’s progress and / or lack of progress.
  • Prepares and conducts lectures on substance use disorders and co-occurring disorders.
  • Maintains knowledge of and adheres to The Walker Center’s policies and procedures.
  • Participates as an effective and contributing member of the counseling team, communicates well and role model’s positive attitudes.
  • Demonstrates knowledge and competency related to confidentiality and ethical standards of the counseling profession.
  • Attends continuing education classes and applies knowledge learned to work at The Walker Center. Shares knowledge with co-workers.
  • Trains, mentors and guides entry level / training counselors as assigned.
  • Works within a team setting- works effectively with a treatment team format, knows how to work with supervision.
  • Obtains Insurance authorizations as needed, provides requested information in a timely manner; tracks, documents, and notifies appropriate departments as required.
  • Works with stakeholders including but not limited to parole officers, attorneys, judges, school officials, diversion court officials, and hospital personnel.


  • Accepts, follows, and sets an example that represents The Walker Center’s policies, philosophy, mission and values.
  • Demonstrates excellent service in all interactions to all those we come into contact with (coworkers, clients, families, vendors, general public).
  • Adheres to an established work schedule.
  • Maintains confidentiality and exercises good judgment about what to say and when to say it.
  • Is a self-starter, exhibits initiative necessary to complete tasks.
  • Possesses ability to prioritize tasks to ensure completion according to significance.
  • Able to work calmly and handle stressful situations which occur during busy periods of time.
  • Consistent in checking accuracy of own work; keeps errors to a minimum and accepts personal responsibility for work.
  • Contributes to a positive work environment through interactions with others.
Requirements:
  • Must hold a valid license in the State of Idaho as an LMSW, LCSW, LPC, LCPC, or LMFT, or meet qualifications for ADC/AADC, or Qualified Professional (QP0 per IDAPA, or equivalent.
  • Two (2) years of experience treating individuals with substance use disorders using individual and group counseling techniques preferred.
  • Excellent oral and written communication skills, with the ability to interact effectively with others.
  • Proficient in Microsoft Outlook and general computer systems, with the ability to learn and maintain Electronic Medical Records (EMR).
  • Ability to operate a variety of office equipment and machinery, including a computer, printer, photocopier, facsimile machine, and telephone.
  • Ability to perform the physical requirements of the position including walking, standing, bending, stooping, pushing, pulling, lifting, typing, and repetitive motions.
  • If in recovery from a Substance Use Disorder, must have a minimum of five (5) years of sobriety from substances of use.
  • Must pass pre-hire requirements including a criminal background check, urinalysis (UA), and TB test.
  • Must obtain CPR certification within ninety (90) days of hire.