- BPA Health Inc (Boise, ID)
- …of BPA Health, collaborating with the Medical Director to ensure clinical excellence throughout the entire suite of services offered. The position is ... quality, adequacy Leading, managing, & holding people accountable Utilization management Clinical service delivery Benefit plan management Customer service… more
- Highmark Health (Boise, ID)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Humana (Boise, ID)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- Molina Healthcare (Meridian, ID)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... case management programs for mental health and chemical dependency services . Works closely with the Regional Medical ...* Supports BH committees for quality compliance. * Implements clinical practice guidelines and medical necessity review… more
- Molina Healthcare (Boise, ID)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... and procedures that guide and support the provisions of medical staff services . Maintains a working knowledge...experience, including: + 2 years previous experience as a Medical Director in a clinical … more
- St. Luke's Health System (Meridian, ID)
- …**Make a Difference Where It Matters Most.** The BE/BCArea Medical Director - Hospice Serviceswill provide strategic and clinical leadership to will ensure ... Qualifications:** + Demonstrated leadership experience + Background in hospice + Hospice Medical Director Board Certification + Fellowship in Hospice and… more
- St. Luke's Health System (Boise, ID)
- …their daily routines. In this role, you will work collaboratively with the IOP Medical Director , IOP Clinical Manager, and a multidisciplinary team of ... clinicians to ensure high-quality, patient-centered care. You'll serve as a clinical resource and patient advocate, helping coordinate care across multiple settings… more
- Prime Therapeutics (Boise, ID)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions...the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership… more
- Highmark Health (Boise, ID)
- …anchor, including MAQCs and pharmacists, in collaboration with the partnership director who manages non- clinical workforce activity. + **Relationship Management ... :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians in leading the day-to-day operational model of… more
- Cognizant (Boise, ID)
- …submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services , investigational/experimental and billing resulting… more
- St. Luke's Health System (Boise, ID)
- …of colleagues, St. Luke's is truly a great place to work. The ** Director of Clinical Review Management** provides strategic and operational leadership across ... satisfaction + Responsible for utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with… more
- Grifols Shared Services North America, Inc (Boise, ID)
- …(MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, ... and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions. The...solutions for the therapeutic area(s). + Partners with the Medical Directors, National MSL Sr Director , and… more
- Humana (Boise, ID)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... , requested level of care, and/or requested site of service should be authorized. All work occurs with a...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Boise, ID)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical ...a Lead Medical Director . The Medical Director conducts post- service , inpatient… more
- Humana (Boise, ID)
- …all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other ... Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert… more
- CenterWell (Boise, ID)
- … Medical Director for Home-Based Care Programs is a key clinical leadership position responsible for the medical direction, clinical oversight, ... polychronic, and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy… more
- Humana (Boise, ID)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on medical ...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Evolent (Boise, ID)
- …non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Evolent (Boise, ID)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other… more
