- 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Molina Healthcare (Meridian, ID)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Boise, ID)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Boise, ID)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Boise, ID)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Molina Healthcare (Meridian, ID)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… 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...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Boise, ID)
- …in a 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...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Boise, ID)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Boise, ID)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- R1 RCM (Boise, ID)
- …enhancing the patient experience. As the Government Navigation Services (GNS) Business Development Director , you will focus on engaging and targeting new Tier 1 and ... in addition to prospecting and networking initiatives, the GNS Business Development Director will partner with the Business Development teams of in-house and… more
- Humana (Boise, ID)
- …of our caring community and help us put health first** The Director , Strategy Advancement provides data-based strategic direction to identify and address business ... support for business segments or the company at large. The Director , Strategy Advancement requires an in-depth understanding of how organization capabilities… more
- Humana (Boise, ID)
- …our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates ... Medicare Advantage and Prescription Drug Plans using approximately 40...management, health outcomes, patient experience, and plan operations. The Director , Stars HOS Improvement and Operations is responsible for… more
- Molina Healthcare (Boise, ID)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- Evolent (Boise, ID)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- Prime Therapeutics (Boise, ID)
- …and drives every decision we make. **Job Posting Title** Trade Client Relations Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Humana (Boise, ID)
- …diverse scope and complexity ranging from moderate to substantial. The Associate Director , Data Quality/Integrity will lead and manage the HEDIS Supplemental Data ... metrics, documentation, quality controls, reporting, and exceptional delivery. The Associate Director will be responsible for ensuring the team lives Humana's… more
- Evolent (Boise, ID)
- …as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial Services utilizes and develops analytical tools to solve ... impact on the organization and patient health. This role supports both medical cost management activities and business development efforts. **What You Will Be… more
- Molina Healthcare (Boise, ID)
- …ideally suited for candidates living in the Eastern Time Zone. Regional Director Quality Solutions (QS) is responsible for contributing to the strategic performance ... + Serves as the subject matter expert for all, Medicaid / Medicare / Marketplace quality, and data acquisition functions to ensure participants understands… more