- Highmark Health (Boise, ID)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Humana (Boise, ID)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Boise, ID)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- CVS Health (Boise, ID)
- …problem-solving abilities **Preferred Qualifications** Clinical Coding Experience - Content Manager Claim Processing Medicaid Working with SQL Application ... and every day. Remote: can work anywhere in the US **Position Summary** Medicaid Claim Editing Content Management team. Must oversee ongoing content delivery and… more
- Prime Therapeutics (Boise, ID)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Humana (Boise, ID)
- …health outcomes for our dual members - members that qualify for both Medicare and Medicaid . The Lead Product Manager sits in the center of strategy, design, ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Prime Therapeutics (Boise, ID)
- …our passion and drives every decision we make. **Job Posting Title** Client Quality Manager Stars and Quality - Remote **Job Description** The Senior Client Quality ... Manager ensures the successful planning, implementation and execution of...provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating… more
- Prime Therapeutics (Boise, ID)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- Molina Healthcare (Meridian, ID)
- …contractual requirements related to government programs including, but not limited to, Medicaid , duals (MMP) and Marketplace. * Serves as primary internal contact ... interpretations. * Monitors daily Government Contracts activities to ensure contractual compliance with state and federal requirements for all lines of business… more
- Humana (Boise, ID)
- …we expand our cloud capabilities, we are looking for a Principal Product Manager to lead our multi-CSP strategy, drive cross-domain collaboration, and optimize our ... customer onboarding experience. As a Principal Cloud Platform Product Manager , you will own the vision, strategy, and execution for our multi-cloud platform-focusing… more
- Prime Therapeutics (Boise, ID)
- …management in the areas of problem identification and resolution, process improvements, compliance with Centers for Medicare & Medicaid Services (CMS) ... passion and drives every decision we make. **Job Posting Title** Vendor Program Manager Senior **Job Description** The Vendor Program Manager is responsible for… more
- Trinity Health (Boise, ID)
- …and procedures. Ensures quality patient care and adheres to regulatory compliance . Provides concurrent assistance and support to physicians and other clinical ... works closely with our Patient Financial Advocates in the Medicaid pending process, and works closely with outside facilities...self to patient and family and explains clinical resource manager role and the process for patient and family… more
- Datavant (Boise, ID)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- Sanofi Group (Boise, ID)
- **Job Title:** Field Reimbursement Manager - Tzield -Northwest **Location** : US Remote (WA/OR/MT/ID/WY/AK) **About the Job** The individual in this role will need ... Management criteria for assigned products + Monitor commercial, Medicare, and Medicaid communications on coverage, utilization management requirements, and coding &… more
- Cognizant (Boise, ID)
- **Credentialing Account Manager (remote)** **This is a remote position open to any qualified applicant in the United States.** **Summary:** The Credentialing Account ... Manager oversees the end-to-end credentialing process for healthcare providers,...coordinates with internal teams to resolve issues and maintain compliance . **Key Responsibilities:** + Act as the primary liaison… more
- Molina Healthcare (Boise, ID)
- …needs, support to other business units + Strong business knowledge related to Medicaid and Medicare lines of business + Reviews enrollment issue trends and provides ... + Ensures compliant with regulatory and company guidelines, including HIPAA compliance + This position primarily focuses on project/program management related to… more
- Molina Healthcare (Boise, ID)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...+ 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting, analysis,… more
- Humana (Boise, ID)
- …plans. Key Accountabilities We are seeking a highly skilled Lead Digital Program Manager to oversee the development and execution of a new eCommerce business. This ... independently, ensuring alignment with strategic objectives. The Lead Digital Program Manager will play a key role in establishing the structure, frameworks,… more
- HCA Healthcare (Caldwell, ID)
- …Specialists (CARS), and/or CDI Liaisons with day-to-day operations + Assists Coding Manager in the review and improvement of processes and services + Ensures ... Review Tool [C-PART)) + Coordinates activities in conjunction with the Coding Manager and SSC Education staff related to the development, education, training, and… more
- Molina Healthcare (Meridian, ID)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid , Medicare, CHIP and Marketplace, applicable State regulatory requirements,… more