Job Details

Medicaid Utilization Review Analyst

  2019-07-11     Department of Health and Welfare     450 West State St/Boise     23.42-26.00 hour  

The Idaho Department of Health and Welfare, Bureau of Audits and Investigations is searching for self-motivated individuals to investigate and ensure Medicaid provider compliance with Medicaid rules, regulations and policies. The current opening is in the Boise office.

These positions are instrumental in protecting the integrity of the Medicaid program. The individuals will conduct preliminary investigations, audit Medicaid billings, and represent the Department as an excellent communicator with providers, in presentations, in hearings, with agencies, and with community businesses. A positive and professional image, excellent research and analytical skills, and decisiveness with the ability to communicate well are critical for this position.

Some travel is required; trips can last from one day to a week.

The successful candidate will be required to pass a background investigation and an expanded reference check.


  • Reviews and analyzes Medicaid Management Information System (MMIS) reports to identify utilization patterns and individual providers or clients who may be abusing the program
  • Develops cases by interviewing providers and clients, conducts on-site reviews, and documents evidence
  • Meets with providers to discuss findings
  • Recommends and participates in development and implementation of policies and procedures for monitoring program utilization
  • Confers with professional medical consultants concerning appropriateness and quality of medical goods and services provided to clients
  • Makes and assists with presentations to internal units, provider groups and Medicaid staff on Utilization Review policy and procedures

To learn more about this position and to apply (by 6/27/19), visit this link:

To view all of our open positions, visit this link: 


Do not contact this company in solicitation of any product or service.

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