- Humana (Boise, ID)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … more
- 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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Boise, ID)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical … more
- 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Boise, ID)
- …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. ... 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)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Molina Healthcare (Caldwell, ID)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Humana (Boise, ID)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
- Evolent (Boise, ID)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Boise, ID)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
- Humana (Boise, ID)
- …our caring community and help us put health first** The Associate Director - Value-based Specialty and Vendor Support role builds templates, standard documentation, ... case studies, and disseminates best in class knowledge. The Associate Director requires a solid understanding of how organization capabilities interrelate across… more
- Humana (Boise, ID)
- …will join the Health Quality and Stars (HQS) leadership team as the Director , Competitive Intelligence to drive the strategic vision of the company's Stars ... ideal candidate will possess a deep understanding of the Medicare landscape, strong analytical skills and the ability to...field + 8+ years of work experience in large national plans, strategic consulting, market analysis and/or finance +… more
- Humana (Boise, ID)
- …community and help us put health first** The Risk Adjustment Compliance Director ensures compliance with governmental requirements. The Risk Adjustment Compliance ... Director requires an in-depth understanding of how organization capabilities...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Boise, ID)
- …and be their most productive. Against that backdrop, we are seeking a Director of Financial Operations of Home Health Solutions who will provide program ... leadership can evaluate alternatives against the organization's business objectives. The Director of Financial Operations requires a strong understanding the Home… more
- Humana (Boise, ID)
- …of our caring community and help us put health first** The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic and ... the development of long-term growth plans and profitability goals The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic… more
- Humana (Boise, ID)
- …Join us in shaping the future of healthcare through AI excellence. The Director of Data Science is responsible for spearheading the development and implementation of ... various departments, including data engineering, product, and business leaders. The Director will help identify opportunities for AI applications, oversee the… more
- CVS Health (Boise, ID)
- …make health care more personal, convenient and affordable. Aetna is seeking a Director of Network Pharmacy to lead Strategy and Performance management across all ... to members. In close partnership with Caremark, the Aetna Director of Network Pharmacy will ensure optimized access points...the network. + Drive clinical and cost interventions for medical and specialty pharmacy by leveraging data and analytics… more
- CenterWell (Boise, ID)
- …Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner ... of management experience + 8 or more years of Medical Coding, IPA, or similar experience + Medical...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record… more
- CVS Health (Boise, ID)
- …division and broader PBM business. This position reports directly to the Director of Medicare Regulatory Affairs. **Duties and Responsibilities:** *Abiity to ... and every day. This Senior Manager, Regulatory Affairs position is a crucial contributor to the Medicare regulatory and operations agenda of the Government Services… more
- Cardinal Health (Boise, ID)
- …policies. **_Consultant, Ethics & Compliance (Audit)_** Reporting to the Compliance Director ( Director ), this position conducts audits to determine ... and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus...and coder education. This position will also support the Director with scheduling and audit planning, as well as… more