- Prime Therapeutics (Boise, ID)
- … clinical research and analytics that improve medical cost savings and provide clinical quality initiatives + Manages current clients in all Medical Pharmacy ... drives every decision we make. **Job Posting Title** Director, Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description Summary** Responsible for… more
- HealthEdge Software Inc (Boise, ID)
- …user experience, client needs and organizational and business priorities, while maintaining the clinical quality and standards of our product. Because you will ... or clinical improvement opportunities. + Lead the clinical review of existing clinical ...author corresponding surveys & alerts that leverage evidence-based guidelines, clinical best practices and key quality improvement… more
- Prime Therapeutics (Boise, ID)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the ... clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting...as needed to discuss cases and problems. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Evolent Health (Boise, ID)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Boise, ID)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Oncology, Physician Clinical Reviewer you will be a key member of the utilization management ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Prime Therapeutics (Boise, ID)
- …our passion and drives every decision we make. **Job Posting Title** Hemophilia Clinical Reviewer (ICR) **Job Description Summary** Facilitates efforts in the ... development of medical pharmacy solutions programs. Supports drug utilization review (DUR) efforts by reviewing physician prescribing patterns, consulting with… more
- CVS Health (Boise, ID)
- …enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to ... when appropriate. - Medical Directors will participate in inter-rater review activities and other quality oversight processes... clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality … more
- CVS Health (Boise, ID)
- …system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is ... responses to members and providers. In addition you will oversee utilization review / quality assurance, directing case management. In this role you'll provide… more
- Evolent Health (Boise, ID)
- …groups to provide exceptional support of timely and accurate delivery of high- quality Evolent clinical guidelines. Our team values collaboration, continuous ... and Legislative/Regulatory Guidelines + Maintain source of truth information related to clinical guidelines application for utilization review requests + Support… more
- CVS Health (Boise, ID)
- …care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is ... **As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews.**… more
- Evolent Health (Boise, ID)
- …with execution of Evolent's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs + Participate in the Appeals ... offer you a meaningful way to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance on a team that values… more
- Intermountain Health (Boise, ID)
- …services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. **Posting Specifics** + Pay ... other (SO). Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Ensures a plan of care is… more
- Edwards Lifesciences (Boise, ID)
- …+ Prepare or review event narratives for internal review (eg R&D, quality , RA) or external review ( Clinical Endpoints Committee), as well as for ... of everything we do. As part of our Medical Clinical Affairs team, you'll foster internal and external collaboration...practices to help impact patient lives and advance the quality of care. Your scientific curiosity and passion for… more
- Evolent Health (Boise, ID)
- …+ Responsible to assist with all types of audits including Interrater, Customer, Clinical quality , and/or confirmation of process changes. + Holds Field Medical ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance...Doing:** + Provides medical direction to the support services review process. Responsible for the quality of… more
- American Heart Association (Boise, ID)
- …and conduct data monitoring activities within registry tool. This position will continually review site and registry-wide data for quality , completeness, and ... or in a public health-related organization, clinical registries, patient registries, clinical studies or quality improvement programs + Experience and proven… more
- Prime Therapeutics (Boise, ID)
- …including documentation of all daily activities. + Performs related duties as requested. + Clinical and Quality oversight for this program is provided by the ... drug infusion services versus the hospital outpatient facility. Discusses financial and clinical considerations with members who are considering care at a higher… more
- Trinity Health (Boise, ID)
- …Type:** Full time **Shift:** Day Shift **Description:** We are looking for a Clinical Research Coordinator to join our team in Boise in support of Oncology ... you have experience working in an NCORP, at least 2 years of clinical research experience, and have previous experience in oncology, let's talk! **POSITION… more
- R1 RCM (Boise, ID)
- … Appeals Supervisor** , you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical ... policies of the payor. Every day you will supervise the day-to-day clinical operations and functions within the department, ensuring productivity and quality… more
- J&J Family of Companies (Boise, ID)
- …on country commitments within assigned therapeutic area(s) and strategic goals. + Review operational and quality metrics regularly and drive follow-up actions ... Manager Clinical Operations, Oncology - 2406214022W **Description** Johnson &...and effectively communicate on priority shifts as required. + Review and approve expenses in compliance with the company… more
- Bausch + Lomb (Boise, ID)
- …teams, primarily with Clinical Operations, Research and Development, Safety, Clinical Trial Materials, Marketing, Regulatory and Quality /Compliance. + Leads ... of difficulty in which analysis of situation or data requires review of identifiable clinical factors and in which scientific and clinical perspectives… more