Job Details

Medicaid Utilization Review Analyst

  2020-07-29     Department of Health and Welfare     3232 Elder St     23.18 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.

This position is instrumental in protecting the integrity of the Medicaid program. The individual 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.

We offer a competitive benefits package which includes excellent medical, dental and vision insurance; generous vacation and sick leave accrual beginning as soon as you start; ten paid holidays a year; participation in one of the nation's best state retirement systems; multiple savings plans and optional 401K; life insurance; wellness programs; ongoing training opportunities; and more.

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.

If you have previously applied for Medicaid Utilization Review Analyst and wish to be considered for the current vacancy, you must reapply under this announcement. Previous scores will not be used.

Example of Duties

  • 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

Minimum Qualifications

You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements.

Good knowledge of:

  • Medical terminology
  • Medical diagnostic and procedural terms
  • Data processing systems as used in program monitoring and management information processes
  • Common medical payment procedural codes used in Current Procedural Terminology Fourth Edition (CPT-4), and other nationally recognized coding references


  • Conducting interviews to obtain facts for cases
  • Recognizing patterns of medical assistance billing that suggest fraud, abuse, over-utilization, child abuse, and claims processing problems
  • Compiling, analyzing, and interpreting statistical data, and developing recommendations
  • Providing verbal and written communication of findings to both internal and external entities

To be considered, apply online by 7/15/2020:


Hiring is done without regard to race, color, religion, national origin, sex, age or disability. If you need special accommodations to satisfy testing requirements, please contact the Division of Human Resources at (208) 334-2263.

Preference may be given to veterans who qualify under state and federal laws and regulations.

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

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