- Idaho Division of Human Resources (Caldwell, ID)
- Medicaid Program Specialist - MED Posting Begin Date: 2025/10/30 Posting End Date: 2025/11/13 Category: Records Management Work Type: Full Time Remote: ... SOON AS POSSIBLE TO BE CONSIDERED.* The Division of Medicaid , Bureau of Care Management (BCM) has an exciting...team monitoring performance and customer care of a dynamic program that interacts with other IDHW programs, care providers,… more
- Molina Healthcare (Caldwell, ID)
- …managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting. + Completion of a ... Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work...and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Highly Qualified Applicants Will Have The… more
- Prime Therapeutics (Boise, ID)
- …every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) Service ... Specialist is responsible for receiving inbound and making outbound...of business to review the benefits of the MTM program . This position speaks with members to gather and… more
- Molina Healthcare (Caldwell, ID)
- …managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting. * Completion of a ... the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive research and… more
- Molina Healthcare (Caldwell, ID)
- …care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting experience. * Completion of ... and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials...a health care related vocational program (ie, certified coder, billing, or medical … more
- Cognizant (Boise, ID)
- …the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member ... clinical denials including but not limited to referral, preauthorization, medical necessity, non-covered services, investigational/experimental and billing resulting in… 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 ... implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a...or sanction by any state or federal health care program , including Medicare or Medicaid , and is… more
- Molina Healthcare (Caldwell, ID)
- …unrestricted in state of practice. + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other… more
- CVS Health (Boise, ID)
- …every day. **Position Summary** Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that ... are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment...tools. + Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and… more
- Humana (Boise, ID)
- …the team as a Senior Product Manager working anywhere in the US. As a Specialist in NBA Execution, you'll play a hands-on role in translating strategy into real-time ... eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Our… more