- 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Boise, ID)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Boise, ID)
- …topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this… more
- Humana (Boise, ID)
- …training, daily work is performed with minimal direction, but with support from other team members. The Medical Director enjoys working in a structured ... caring community and help us put health first** The Medical Director actively uses their medical...of the managed care industry including Medicare Advantage, Managed Medicaid , or other Medical management organizations, hospitals/… more
- Humana (Boise, ID)
- …outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director . ... caring community and help us put health first The Medical Director actively uses their medical...of integrity, professionalism, resourcefulness, and enjoy working in a team -based environment. Medical Directors support Humana value… more
- Humana (Boise, ID)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Boise, ID)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Boise, ID)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- CenterWell (Boise, ID)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical … more
- Evolent (Boise, ID)
- …for 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 . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Boise, ID)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Boise, ID)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Boise, ID)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Baylor Scott & White Health (Boise, ID)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare/ Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the..., Denial Resource Center will lead a highly skilled team of Registered Nurses, Certified Coding Specialists, Complex Appeal… more
- Humana (Boise, ID)
- …part of our caring community and help us put health first** The Associate Director of DevOps Engineering is a strategic and technical leadership role responsible for ... guiding our DevOps initiatives. You will lead a team of talented DevOps engineers, focusing on standardization, building partnerships with software delivery teams to… more
- Humana (Boise, ID)
- …community and help us put health first** We're looking for an experienced and passionate Director of AI Engineering to lead a team focused on building agentic AI ... adoption and impact of agentic AI across diverse business domains. **Key Responsibilities** ** Team Leadership:** Lead and grow a team of AI engineers building… more
- Sumitomo Pharma (Boise, ID)
- …a dynamic, highly motivated, and experienced individual for the position of Associate Director , Market Access Engagement - Rare Disease, who will act as the face ... families. This person must enjoy working within a high-functioning team with the goal to help everyone succeed for...(commercial and government payers to include FFS and Managed Medicaid ) and remove reimbursement barriers to treatment + Build… more
- Humana (Boise, ID)
- …managed care or provider sector **Reporting Relationships** The role reports to a Director within the Strategy team , works collaboratively with leaders and ... largest health benefits organizations in the country. The Healthcare Strategy team supports Humana's Insurance segment. This segment, Humana's largest, comprises the… more
- Humana (Boise, ID)
- …us put health first** Join a 100% remote, highly specialized offensive security team where collaboration and continuous learning drive our success. We foster a ... supportive environment focused on collective growth and technical excellence, where every team member contributes to our shared mission. You will have access to Hack… more
- Molina Healthcare (Nampa, ID)
- …supporting both the local markets and national value based contracting team . Ensures smooth communication, supports proposal and counter-proposal development, tracks ... network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics… more