- PacificSource (Boise, ID)
- …utilize each person's talents and strengths. The Provider Network Dental Program Manager serves as PacificSource's Medicaid dental industry and benefits subject ... responsibility to provide key support for the administration of PacificSource's Medicaid dental benefit. Responsibilities include managed dental care entity (or… 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
- 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)
- …for operational and strategic analysis. Maintains existing portfolio of compliance and operational reports. KNOWLEDGE/SKILLS/ABILITIES + Collaborates with customers ... and plans for closing gaps.Performs other duties as assigned by the Analytics Manager . + Completes training courses set forth by Analytics team manager .… more
- Molina Healthcare (Meridian, 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 (Meridian, 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
- 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
- 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 (Meridian, 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)
- …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 (Meridian, 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 (Meridian, 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
- CenterWell (Boise, ID)
- …CenterWell ACO and Medicare payment model programs via the Center for Medicare and Medicaid Services (CMS), such as ACO REACH, MSSP, and future models. Under general ... operations including program administration, contract oversight, process, performance improvement, compliance , governance, training, and more. Additionally, this role will… more
- CenterWell (Boise, ID)
- …of outcome data, policy, procedure, and records issues. . Assure personal compliance with licensing, certification, and accrediting bodies. **Use your skills to make ... Medicine . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Excellent verbal and written communication skills . Superior… more
