Medical Review Nurse -UM/Post Appeals (Michigan RN license req) Molina Healthcare IncMedical Review Nurse -UM/Post Appeals (Michigan RN license req)Caldwell, IDREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Medical Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidBoise, IDFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
MEDICAL RECORDS COORDINATOR I - ST. MARIES FAMILY MEDICINE Surgery Partners IncMEDICAL RECORDS COORDINATOR I - ST. MARIES FAMILY MEDICINESaint Maries, IDThe Medical Records Coordinator I supports the clinic Medical Records function and is responsible for assuring that all clerical duties are accurately performed in completion of, but not limited to, the following areas: Pull medical records for other departments and/or individuals as requested. Northwest Specialty Hospital includes 12 operating rooms and 28 inpatient beds, along with a variety of clinics and services throughout Kootenai County, that span across multiple specialties.
MEDICAL RECORDS COORDINATOR II - AXIS SPINE CLINIC Surgery Partners IncMEDICAL RECORDS COORDINATOR II - AXIS SPINE CLINICPost Falls, IDThe Medical Records Coordinator II supports the clinic Medical Records function and is responsible for assuring that all clerical duties are accurately performed in completion of, but not limited to, the following areas: Pull medical records for other departments and/or individuals as requested. Northwest Specialty Hospital includes 12 operating rooms and 28 inpatient beds, along with a variety of clinics and services throughout Kootenai County, that span across multiple specialties.
Medical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)Fort Hall, ID$50,460–$72,644 / yearRequired as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Refer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
Medical Records Technician US Department of Health and Human ServicesMedical Records TechnicianFort Hall, IDMENU Sign in My jobs Profile Resumes & documents Search preferences Notifications Sign out My jobs Profile Resumes & documents Notifications Search preferences Sign out Events Help Center Search Back to results Apply Medical Records Technician Department of Health and Human Services Indian Health Service Various locations across the Agency Apply Print Share Save. Perform a variety of medical records technician duties which include the complete and accurate process and maintenance of hybrid paper-electronic environment of analyzing filing compiling scanning releasing information retrieving and dispatching charts and documents file managing archiving Third Party and entering data of treatment provided to patients within a complex health care facility.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadBoise, IDRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
Technical Records Specialist 1 State of IdahoTechnical Records Specialist 1Boise, IDResearching a variety of sources to resolve problems: typically gained by at least six (6) months of experience performing research and analysis of complex or technical material requiring in-depth program knowledge in order to determine if requirements were met and if they complied with established laws, policies, and/or procedures. This position is responsible for reviewing and processing documentation, maintaining accurate case records, ensuring compliance with IDVR policies and state/federal regulations, and delivering high-quality customer service to students, participants, staff, and other stakeholders.
Corporate Fair & Responsible Banking Analyst-Loan Review Glacier Bancorp IncCorporate Fair & Responsible Banking Analyst-Loan ReviewCoeur D Alene, ID$75,663.07–$113,494.60 / yearStrong knowledge of Fair Lending regulations is required: Home Mortgage Disclosure Act, Equal Credit Opportunity Act, Fair Housing Act, Service Members Civil Relief Act, Fair Debt Collection Practices Act, Fair Credit Reporting Act, Truth In Lending Act, Unfair Deceptive or Abusive Acts or Practices, Real Estate Settlement Procedures Act, Mortgage Acts and Practices. Key responsibilities include fair lending and compliance reviews, lead FARB's risk assessment program, and the oversight of FARB-related models and non-model tools in partnership with analysts, ERM-Model Risk Management, and other stakeholders.
TECH RECORDS SPEC 1 - Veterans Services State of IdahoTECH RECORDS SPEC 1 - Veterans ServicesLewiston, IDThe ideal candidates will be proactive, professional, and self-motivated, possessing exceptional customer service and organizational skills, pays attention to detail and has some financial office experience. The Idaho Division of Veterans Services (IDVS) is recruiting for a full-time Technical Records Specialist 1 position to support the Business Office at the Lewiston Veterans Home.
Technical Records Specialist 1 - PH State of IdahoTechnical Records Specialist 1 - PHBoise, IDThe main duties of this position on the Vital Records Customer Service team includes downloading and processing online certificate applications, processing mailed in certificate applications, and providing telephone assistance to customers. The Idaho Bureau of Vital Records and Health Statistics is the official custodian of confidential certificates of birth, death, stillbirth, miscarriage, marriage and divorce events that occur in the State of Idaho.
Technical Records Specialist 2 - Fingerprinting-BIC State of IdahoTechnical Records Specialist 2 - Fingerprinting-BICBoise, IDThis individual will be responsible for entering and processing fingerprint cards, assisting school districts and applicants with the background check process, perform data entry, and provide quarterly escrow account balances. As such, employees working at a non-classified agency are considered vested in the PERSI retirement system after five (5) consecutive months of service, versus five (5) years of service at a classified agency.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Boise, IDFull timeAfter completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service. Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Mental Health Reviewing Consultant (Bid) MaximusMental Health Reviewing Consultant (Bid)Boise, IDFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Alternate Vision Reviewing Physician Consultant (BID) MaximusAlternate Vision Reviewing Physician Consultant (BID)Idaho Falls, IDFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Maintain working knowledge of Office of Personnel Management (OPM) medical and suitability policies and ensure all consultations reflect current clinical best practices, regulatory requirements, and program objectives.
Behavioral Health Medical Director - AI Policy & Governance CVS Health CorpBehavioral Health Medical Director - AI Policy & GovernanceID$174,070–$374,920 / yearRole summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)including predictive models and generative AIis designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable. -Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust.