- State of Idaho (Boise, ID)
- …of Human Resources and the Idaho Personnel Commission. The Division of Medicaid has an exciting career opportunity or a dynamic forward-thinking, innovative ... communication skills who can excel under pressure as a Medicaid Deputy Administrator . This position will be located...programs can be found here: EXAMPLE OF DUTIES: Oversee compliance with and implementation of state and federal regulations… 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
- Sumitomo Pharma (Boise, ID)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Molina Healthcare (Boise, ID)
- …with other Core Ops areas of responsibilities) within Medicare and Medicaid . Role is predicated on building relationships with vendors, stakeholders, functional ... vendor performance involving onshore and offshore resources, monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality… 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
- Idaho Division of Human Resources (Boise, ID)
- Medicaid Deputy Administrator - MED Posting Begin Date: 2025/07/10 Posting End Date: 2025/07/31 Category: Administration Work Type: Full Time Remote: Flexible Hybrid ... of Human Resources and the Idaho Personnel Commission. The Division of Medicaid has an exciting career opportunity or a dynamic forward-thinking, innovative… more
- Molina Healthcare (Boise, ID)
- …integration, and a strong understanding of data governance and compliance in healthcare environments. **Knowledge/Skills/Abilities:** * Architect and implement ... Deploy, monitor, and troubleshoot Hadoop-based infrastructure using tools such as Cloudera Manager , Ambari, and Zookeeper. * Enforce data quality, security, 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
- Molina Healthcare (Boise, ID)
- **Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid , Medicare, and ... protocols to support efficient and compliant subrogation operations across Medicaid , Medicare, and Marketplace populations. + Collaborate with legal, claims,… 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
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Manager , Technology Solutions devises an effective strategy for executing and delivering on IT ... business initiatives. The Manager , We are seeking a highly skilled and motivated...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Molina Healthcare (Boise, ID)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Negotiates agreements ... Tighter knit proximity ongoing after contract. * In conjunction with Director/ Manager , Provider Contracts, negotiates Complex Provider contracts including but not… more
- Humana (Boise, ID)
- …help us put health first** Humana's Marketing organization is seeking a Senior Product Manager who specializes in Next Best Action (NBA) execution to join the team ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Boise, ID)
- …position requires a current South Carolina pharmacist license **Job Summary** The Pharmacy Manager , Health Plan Pharmacy Services is an integral role of the Health ... the team in understanding pharmacy quality, cost effectiveness and compliance and working closely with the Pharmacy Director or...good standing. + Must be free of sanctions from Medicaid or any other government program and without restrictions… more
- Humana (Boise, ID)
- …us put health first** We're seeking a strategic, results-driven Lead Product Manager to design and deliver innovative clinical solutions that improve health outcomes ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… 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
- Cardinal Health (Boise, ID)
- …* Process all patient applications in accordance to set policy, procedures and PHI compliance * Speak with manufacturer field team members on case updates via phone ... benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred… more
- Molina Healthcare (Boise, ID)
- …our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role ... will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and regulatory guidance. The… more
- Molina Healthcare (Boise, ID)
- …outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence Programs for STAR, HEDIS ... to ensure prompt resolution of identified issues. * Ensures compliance with all CMS guidelines and reporting requirements for...recommended changes to drug therapy were implemented. * Assists Manager or Director in the collection and tabulation of… 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
