What Jobs are available for Medical Assistants in Boise?

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J

**JOB DESCRIPTION**
**Job Summary**
Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.
**Job Duties**
+ Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
+ Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity.
+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.
+ Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.
+ Reviews quality referred issues, focused reviews and recommends corrective actions.
+ Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.
+ Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer.
+ Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process.
+ Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care.
+ Ensures that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.
+ Ensures that medical protocols and rules of conduct for plan medical personnel are followed.
+ Develops and implements plan medical policies.
+ Provides implementation support for Quality Improvement activities.
+ Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.
+ Fosters Clinical Practice Guideline implementation and evidence-based medical practice.
+ Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.
+ Actively participates in regulatory, professional and community activities.
**JOB QUALIFICATIONS**
**REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:**
+ Doctorate Degree in Medicine
+ Board Certified or eligible in a primary care specialty
**REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:**
+ 3+ years relevant experience, including:
+ 2 years previous experience as a Medical Director in a clinical practice.
+ Current clinical knowledge.
+ Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
+ Knowledge of applicable state, federal and third party regulations
**REQU** **I** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:**
Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
**PR** **E** **FE** **R** **RED ED** **U** **C** **A** **TI** **O** **N** **:**
Master's in Business Administration, Public Health, Healthcare Administration, etc.
**PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:**
+ Peer Review, medical policy/procedure development, provider contracting experience.
+ Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
+ Experience in Utilization/Quality Program management
+ HMO/Managed care experience
**PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:**
Board Certification (Primary Care preferred).
**PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Employment Type:**
Full time
**Shift:**
Day Shift
**Description:**
At Saint Alphonsus, we are more than just a workplace-we are a purpose-driven community. Here, every role matters, every voice is valued, and every colleague is empowered to excel. Trust, respect, and teamwork are not just ideals; they are the foundation of how we work and grow together.
**Sign-on and relocation allowance available**
**Benefits starting date of hire**
**Competitive salary**
Ensures accuracy of all radiation measurements in all radiation oncology programs provided by or affiliated with Saint Alphonsus Regional Medical Center (SARMC) through periodic checks and records maintenance. Participates in ongoing meetings and chart reviews for department procedural accuracy. Oversees brachytherapy procedures for safety, accuracy, and record maintenance. Assures accurate commissioning of radiation equipment and calibration. Contributes to administrative functions such as NRC documentation, Radiation Safety Committee, and department policies & procedures review.
**SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:**
+ Master's degree in Medical Physics required or current certification by the American Board of Radiology.
+ Successful completion of Part I and II of the American Board of Radiology certification exam with successful certification by The American Board of Radiology within 3 years of hire.
+ One year of experience as a medical physicist in a cancer treatment setting.
**GOOD TO HAVE:**
+ Experience in a Varian treatment environment.
+ Preferred experience with external beam treatment planning including SRS, SBRT, IMRT, and 3DCRT Preferred experience with brachytherapy treatment planning Preferred experience with Sun Nuclear quality assurance devices.
+ Preferred experience with 4D CT and gated radiation therapy and Vision RT/OSMS.
**HIGHLIGHTS AND BENEFITS:**
When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.
+ We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.
+ Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.
+ We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.
Visit to learn more!
**MINISTRY/FACILITY INFORMATION**
Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.
+ Top 15 Health Systems in the country by IBM Watson Health.
+ The region's most advanced Trauma Center (Level II).
+ Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life.
**Our Commitment**
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran

**Employment Type:**
Full time
**Shift:**
Day Shift
**Description:**
Our Saint Alphonsus Medical Dosimetrist prepares radiation isodose plans for physicians. Interprets radiologic images, anatomy, dose distribution, dose characteristics, and current treatment planning techniques, devices and methods. Contributes to ongoing departmental procedural accuracy through quality assurance activities. Participates in brachytherapy procedures. Participates in assurance of accuracy and timeliness of all physics and dosimetry charges.
**SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:**
1. Graduate of an accredited Medical Dosimetry program (as recognized through JRCERT) or a Certified Radiation Therapist through ARRT with 2 or more years experience as a Medical Dosimetrist.
2. Certified as a Medical Dosimetrist by the Medical Dosimetrist Certification Board (MDCB) required within 12 months of eligibility as defined by the MDCB.
3. Bachelor's degree specifically in Radiation Therapy, Math, or Physics preferred
4. Registered as a Technologist (RT) and certified in Radiation Therapy (T) by the American Registry of Radiologic Technologists (ARRT) preferred.
5. Two to three years of experience as Medical Dosimetrist in a cancer treatment setting preferred.
**HIGHLIGHTS AND BENEFITS:**
When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.
+ We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.
+ Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.
+ We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.
Visit to learn more!
**MINISTRY/FACILITY INFORMATION**
Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.
+ Top 15 Health Systems in the country by IBM Watson Health.
+ The region's most advanced Trauma Center (Level II).
+ Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life.
**Our Commitment**
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran

**Overview**
St. Luke's Health System in Boise, Idaho is looking for a full-time Board Certified/Board Eligible Dosimetrist to work with our highly collaborative and patient-focused team at St. Luke's Cancer Institute. The selected individual will be joining a team of six dosimetrists in an Aria/Eclipse environment. We are looking for someone familiar with all types of planning, including special procedures.This role offers great work/life balance, retirement and health-care benefits, PTO, and possible sign-on and relocation bonuses.
**Responsibilities**
+ Plans external beam treatments under the direction of the radiation oncologist and medical physicist.
+ Contours normal anatomy on medical images and performs registration of multiple imaging modalities under the direction of the radiation oncologist. Reviews doses to targets and critical structures with the radiation oncologist.
+ Participates in the development and implementation of new treatment/immobilization techniques. May include bolus and custom shielding.
+ Assists with simulations, fabrication of treatment devices, and consultation on complex cases. Provides consultation to radiation therapists on patient setups, treatments, and simulations.
+ Completes all pertinent documentation of treatment plans, patient dose calculations, special treatment instructions, and charges.
+ Consults on fabrication of custom treatment devices with therapists
+ Performs other duties and responsibilities as assigned.
**Technologies**
+ 5 matched Varian TrueBeam Linacs
+ 1 Varian STx TrueBeam with HDMLC
+ Bravos Afterloader
+ ExacTrac Dynamic Precision Patient Monitoring System
+ 4 CT simulators with Varian RGSC 4DCT
**Software**
+ Aria Record & Verify
+ Eclipse 16.1 (v.18 in Fall 2024)
+ RapidPlan
+ MCO
+ GPU Computing
+ Brainlab
+ Cranial
+ Multimets
+ Radformation
+ AutoContour
+ ClearCheck
+ ClearCalc
+ EZFluence
**Qualifications**
+ Education: Bachelor's degree or 4 years additional work experience in dosimetry in lieu of degree.
+ Experience: 0 years in radiation oncology setting.
+ Licenses/Certifications: Certified medical dosimetrist.
**What's in it for you**
At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
**Default: Location : City** _Boise_
**Category** _Clinical Technologist / Technicians_
**Work Unit** _Physics Boise_
**Position Type** _Full-Time_
**Work Schedule** _DAY_
**Requisition ID** _ _
**Default: Location : Location** _US-ID-Boise_
**Work Location : Name** _190 E Bannock St, Boise, South Tower_

**Overview**
St. Luke's Health System in Boise, Idaho is looking for a full-time Board Certified/Board Eligible Medical Physicist to work with our highly collaborative and patient-focused team at St. Luke's Cancer Institute. The selected individual will be joining a team of physicists and physics assistants in an Aria/Eclipse environment with Varian TrueBeam linear accelerators. This role offers great work/life balance, retirement and health-care benefits, PTO, and sign-on and relocation bonuses.
**Responsibilities**
+ Ensures that all treatment machines and radiation sources are correctly calibrated according to accepted protocols.
+ Ensures that all radiation safety requirements throughout the facility are met in collaboration with the hospital Radiation Safety Officer.
+ In coordination with other team members, develops and maintains a QA program.
+ Ensures that the beam and source data are accurate and correctly entered into the treatment planning system.
+ Establishes treatment planning and dose calculation procedures that are used throughout the department, and ensures their accuracy.
+ In consultation with the radiation oncologists and dosimetrists, oversees treatment planning and determination of radiation dose distributions in patients undergoing treatment.
+ Ensures policies and procedures contain proper elements of good radiation oncology practice, delivery of treatment, radiation safety, quality control, and regulatory compliance.
+ Releases a treatment machine into clinical service after maintenance, and documents that any alteration caused by the maintenance and repair schedule does not affect the accelerator performance or calibration.
+ Performs other duties and responsibilities as assigned.
+ Ensures that all treatment machines and radiation sources are correctly calibrated according to accepted protocols.
**Technologies**
+ 5 matched Varian TrueBeam Linacs
+ 1 Varian STx TrueBeam with HDMLC
+ Bravos Afterloader
+ ExacTrac Dynamic Precision Patient Monitoring System
+ 4 CT simulators with Varian RGSC 4DCT
+ SunNuclear IC Profiler-base monthly QA procedures
+ EPID Portal Dosimetry
**Software**
+ Aria Record & Verify
+ Eclipse 18
+ RapidPlan
+ MCO
+ GPU Computing
+ Brainlab
+ Cranial
+ Multimets
+ Radformation
+ AutoContour
+ ClearCheck
+ ClearCalc
+ EZFluence
+ QuickCode
**Qualifications**
+ Education: Master's degree in Medical Physics or a related field
+ Experience: 2 years in radiation oncology physics setting or completion of CAMPEP accredited residency.
+ Licenses/Certifications: Certification in Therapeutic Radiological Physics (TRP) or Therapeutic Medical Physics (TMP) by the ABR or ABMP
**What's in it for you**
At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
**Default: Location : City** _Boise_
**Category** _Professional_
**Work Unit** _Physics Boise_
**Position Type** _Full-Time_
**Work Schedule** _VARIABLE_
**Requisition ID** _ _
**Default: Location : Location** _US-ID-Boise_
**Work Location : Name** _190 E Bannock St, Boise, South Tower_

**Company :**
Highmark Inc.
**Job Description :**
**JOB SUMMARY**
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members
**ESSENTIAL RESPONSIBILITIES**
+ Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
+ Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
+ Participate in protocol and guidelines development to ensure consistency in the review process.
+ Actively manage projects and/or participate on project teams that require a physician subject matter expert.
+ Other duties as assigned.
**EDUCATION**
**Required**
+ Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
**Substitutions**
+ None
**Preferred**
+ Master's Degree in Business Administration/Management or Public Health
**EXPERIENCE**
**Required**
+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
**Preferred**
+ 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
**LICENSES AND CERTIFICATION**
**Required**
+ Medical Doctor or Doctor of Osteopathic Medicine (DO)
+ Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
+ Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.
**Preferred**
+ None
**SKILLS**
+ Critical Thinking
+ Case Management
+ Customer Service
+ Oral & Written Communication Skills
+ Collaboration
+ Listening
+ Telephone Skills
+ General Computer Skills
+ Clinical Software
+ Managed Care
**Language (Other than English)**
None
**Travel Required**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$170,000.00
**Pay Range Maximum:**
$352,500.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J

JOB DESCRIPTION Job Summary
Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Determines appropriateness and medical necessity of health care services provided to plan members.
- Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. -Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization.
- Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
- Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity.
- Participates in and maintains the integrity of the appeals process, both internally and externally.
- Responsible for investigation of adverse incidents and quality of care concerns.
- Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications.
- Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams.
- Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.
- Reviews quality referred issues, focused reviews and recommends corrective actions.
- Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.
- Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer.
- Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process.
- Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care.
- Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care.
- Ensures medical protocols and rules of conduct for plan medical personnel are followed.
- Develops and implements plan medical policies.
- Provides implementation support for quality improvement activities.
- Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed.
- Fosters clinical practice guideline implementation and evidence-based medical practices.
- Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management.
- Actively participates in regulatory, professional and community activities.
Required Qualifications
- At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience.
- Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice.
- Board certification.
- Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
- Ability to work cross-collaboratively within a highly matrixed organization.
- Strong organizational and time-management skills.
- Ability to multi-task and meet deadlines.
- Attention to detail.
- Critical-thinking and active listening skills.
- Decision-making and problem-solving skills.
- Strong verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
Preferred Qualifications
- Experience with utilization/quality program management.
- Managed care experience.
- Peer review experience.
- Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Overview**
The Medical Lab Scientist 2 is responsible for performing routine tests in clinical laboratories for use in treatment and diagnosis of diseases. Handles moderately complex issues and problems and possesses solid working knowledge of subject matter. Relies on experience and judgment to plan and accomplish goals. A general degree of creativity and latitude is required. May act as a mentor/trainer to junior members of team.
+ Tests specimens in an accurate, organized and prioritized manner following laboratory procedures and policies to ensure quality and time guidelines in accordance with all regulatory agency requirements.
+ Collects a variety of specimens as required by specific section needs, with skill and sensitivity to needs of the patient.
+ Ensures specimens are properly identified, collected, labeled and stored.
+ Performs instrument maintenance according to section procedures.
+ May provide mentorship & training to others.
+ Maintains inventory of supplies.
+ Maintains a safe and clean working environment.
+ Follows department policy maintaining all necessary records and documentation.
+ Ensures input is accurate and complete.
+ Performs other duties as assigned.
**Qualifications:**
+ Education: Bachelor's degree in scientific related field.
+ Experience: 2 years experience.
+ Certification: Must have one of the following:
+ Blood Banking (ASCP_BB)
+ Chemistry (ASCP_C)
+ Cytogenetics (CYGT)
+ Hematology (ASCP_H)
+ Microbiology (ASCP_M)
+ Molecular Biology (ASCP_MB)
+ Medical Lab Scientist (ASCP_MLS or AMT_MLS)
+ Medical Technologist (ASCP_MT or AMT_MT)
**What's in it for you**
At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
**Default: Location : City** _Boise_
**Category** _Laboratory_
**Work Unit** _Laboratory Boise Hospital Flr 1_
**Position Type** _Full-Time_
**Work Schedule** _NIGHT_
**Requisition ID** _ _
**Default: Location : Location** _US-ID-Boise_
**Work Location : Name** _190 E Bannock St, Boise, Boise Medical Center_