Job Listings

At St Luke's Health Plan our dedicated team strives to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.   What You Can Expect: - Monday-Friday schedule  - Hours are 8-5 - Full Benefits with hospital contributions - Answers eligibility questions, takes payments, and educates members and groups regarding billing and payment processes - Resolves member inquiries - Provide responsive and professional services and support to accounts and business partners.   Qualifications: - Education: High School diploma or equivalent

At St Luke's Health Plan our dedicated team strives to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.     What You Can Expect: - Monday-Friday schedule  - Hours are 8-5 - Full Benefits with hospital contributions - Develops, trains, and supervises the Membership & Enrollment team - Working team member    Qualifications: - Education: High School diploma or equivalent - Experience: 4 years relevant experience Preferred Experience:  - Leading or supervising others - Membership or enrollment experience preferrably in a health plan setting 

The Business Analyst partners across business segments within the St. Luke's Health Plan to support the development of business processes and delivery of insights and health insurance data analysis that are in alignment with identified strategies and tactics, while working with cross-functional stakeholders. - Supports the analysis and interpretation of health insurance data, including eligibility, premium, medical, and pharmacy claims data. Works to develop subject matter expertise on available health insurance data. A creative problem solver in applying that data to identify, escalate, and resolve operational issues. - Understands and interprets operational processes and business context to translate technical, clinical, financial, and operational problems into analysis, which yield insights and information to support decision making. - Will collaborate with business owners to develop expertise with one or more health insurance regulatory programs and requirements, as well as associated data, such as HEDIS/quality programs, risk adjustment, or utilization management. - Supports high value health insurance data analysis, assisting with the calculation and interpretation of key business metrics to aid business leaders and key stakeholders for decision making and operational planning. - Supports business decisions with analytical rigor, insights, and judgments to drive better decisions. - Partners with internal Data & Analytics team to define scope, requirements, data validation, and provide prioritization input on requests and needs. Collaborates with vendors and other external parties to develop data requirements and ensures appropriate data validation and integrity. - Works with and contributes to data management and data governance to understand and help define data policies and standards to ensure high quality data and analytics. - Develops and maintains a high degree of functional, analytical, and technical acumen. Builds successful partnerships with key internal customers and cross functional teams. - Performs assigned reporting tasks for colleagues in other functions. - Participates in special projects and on workgroups and teams, as assigned. - Completes other duties and responsibilities as assigned.      

The Intake Coordinator position plays an important role in managing and processing the authorization of medical services, procedures, and treatments in accordance with established guidelines and policies. This individual will work closely with healthcare providers, internal teams, and external partners to ensure efficient and accurate authorization processes. - Review, evaluate, and process authorization requests for medical procedures, treatments, and services according to established guidelines and policies. - Verify completeness and accuracy of required documentation accompanying authorization requests, ensuring compliance with regulatory standards. - Collaborate with healthcare providers to obtain necessary information or clarification on authorization requests, ensuring a clear understanding of requirements. - Stay updated on insurance policies, guidelines, and industry regulations to ensure proper authorization procedures and compliance. - Collaborate with internal departments such as claims, customer service, and medical management to ensure seamless coordination and timely processing of authorizations. - Assist with quality checks to ensure accuracy in authorization processing, minimizing errors and ensuring adherence to company standards. - Assist in addressing and resolving any issues or concerns related to authorization, escalating complex cases to the appropriate channels as needed. - Maintain accurate records of authorization activities. - Performs other duties and responsibilities as assigned.   Qualifications: - Education: High School diploma or equivalent - Experience: 0 year's relevant experience - Licenses/Certifications: None  

Under general supervision, the Accountant provides support and assistance to the accounting team by performing routine accounting assignments, moderately difficult in nature, requiring a broad knowledge of accounting theory and principles. The Accountant provides support in finance related areas, development and improvement of processes, and compliance with regulatory and internal policies, rules, and standards. - - Prepares routine journal entries and maintains supporting files and documentation. - Assists in the preparation and monitoring of invoices, purchase orders, and supports expenditures and deposits. - Reviews and analyzes accounts and reconciles Health Plan related accounts to assure posting accuracy and correct processing. - Responsible for General Ledger Activity (reviewing, compiling, summarizing) and preparing financial reports. - Responsible for establishing and maintaining accounting policies and controls. - Prepares documents for annual and quarterly financial statements as required by the Idaho Department of Insurance and/or St. Luke's Health System, working with both generally accepted accounting principles and statutory accounting principles. Provides technical support to internal and external auditors as well as regulatory auditors, as requested. - Provides financial support including forecasting, budgeting, and analyzing variations from budget. Assists department leaders on variances from budget/actual. - Assists with the organization's budgeting and financial reporting process for the purpose of improving financial performance and efficiency. - Resolves problems using working knowledge of procedures and policies. Performs moderately complex work requiring independent judgement and practical application of advanced accounting theory. - Other duties and responsibilities as assigned.     Qualifications: - Education: Bachelor's degree - Experience: 2 years relevant experience - Licenses/Certifications: None    

St. Luke’s Health System in Boise, ID is seeking a Business Analyst - St. Luke's Health Plan to join our Health Plan team.   Unit/Position Summary: The Business Analyst serves as a strategic partner to the business segments within the St. Luke’s Health Plan. In alignment with identified strategies and tactics, leads the development of business processes and delivery of insights and health insurance data analysis, while working with cross-functional stakeholders.       - Analyzes and interprets health insurance data, including eligibility, premium, medical, and pharmacy claims data. Subject matter expert on available health insurance data. A creative problem solver in applying that data to identify, escalate, and resolve operational issues. - Understands and interprets operational processes and business context to translate technical, clinical, financial, and operational problems into analysis, which yield insights and information to support decision making. - Expertise with health insurance regulatory programs and requirements, as well as associated data, including HEDIS/quality programs, risk adjustment, and utilization management. - Performs high value health insurance data analysis, interpretation of key business metrics, and presents insights to business leaders and key stakeholders to aid decision making and operational planning. - Challenges and supports business decisions with analytical rigor, insights, and judgments to drive better decisions. - Partners with internal Data & Analytics team to define scope, requirements, data validation, and provide prioritization input on requests and needs. Collaborates with vendors and other external parties to develop data requirements and ensures appropriate data validation and integrity. - Works with and contributes to data management and data governance to understand and help define data policies and standards to ensure high quality data and analytics. - Develops and maintains a high degree of functional, analytical, and technical acumen. Builds successful partnerships with key internal customers and cross functional teams. - Responsible for and performs all but the most complex assignments and work requiring independent judgment and decision making. Serves as a subject matter expert for colleagues in other functions. - Leads special projects and participates on workgroups and teams, as assigned.   Qualifications (Minimum qualifications required for the job) • Education: Bachelor’s degree or experience in lieu of degree • Experience: 3 years of relevant experience • Licenses/Certifications: Non   Preferred qualifications - 2 or more years of experience in a role analyzing health insurance data focused on measuring utilization or financial outcomes - Knowledge and experience using SQL to manipulate and analyze health insurance data - Advanced proficiency in Excel, with experience using functions like INDEX, MATCH, and SUMPRODUCT    

St. Luke’s Health System in is seeking a Utilization Management Nurse for St. Luke's Health Plan to join our team.   St. Luke’s Health Plan is a wholly-owned, not-for-profit subsidiary of St. Luke’s Health System, offering health insurance coverage for individuals, families and employers across south central and southwestern Idaho. Building on more than 120 years of committed service to Idaho, St. Luke’s Health Plan is on a bold and ambitious mission to redefine the coverage to care experience, removing barriers for both members and providers and creating a more seamless, hassle-free experience.   Summary: This role is responsible for reviewing and assessing requests for medical procedures, treatments, services, and inpatient admissions to ensure they meet medical necessity criteria. This position plays a vital part in the timely and accurate review of preauthorization requests, facilitating the best possible care for St. Luke's Health Plan members while managing healthcare costs. It requires excellent written and verbal communication skills.   Responsibilities: - Evaluate preauthorization requests from healthcare providers to determine coverage relative to benefits, medical necessity, appropriateness, and efficacy of requested medical services or procedures. - Conduct clinical and concurrent reviews by analyzing medical records, diagnostic tests, and physician notes to make informed decisions regarding the approval or denial of preauthorization requests and inpatient admissions. - Ensure that all decisions and approvals align with the company's medical necessity criteria, clinical guidelines, and evidence-based best practices. - Collaborate with healthcare providers, members, and internal teams to gather additional information, clarify clinical information, or discuss decision outcomes. - Maintain thorough and accurate records of preauthorization decisions, communications, and supporting documentation in compliance with company and regulatory standards. - Strive to achieve prompt preauthorization decisions to support timely access to care for our members. - Stay updated on evolving medical guidelines, standards, and industry trends to make well-informed and evidence-based decisions. - Contribute to the enhancement of utilization management processes, procedures, and guidelines by identifying areas for improvement. - Write and send notification to members and providers regarding utilization management determinations, using plain language that is easy for a layperson to understand. - Perform other duties as assigned.   Qualifications: - Education: Bachelor of Science in Nursing (BSN) - Experience: 3 years relevant experience - Licenses/Certifications: Current RN licensure in state of practice  

The Director Business Development/Sales plays a key role in executing the sales strategy and driving growth for St. Luke's Health Plan. With focus on maintaining and increasing the Health Plan client partnerships in the Large Employer segment, this role will have a direct impact in an area of significant opportunity to be able to offer solutions to a broad spectrum of employers in the communities we serve.   Responsibilities - Develops and executes a strategy to grow the Health Plan products' sales, taking into consideration broker relationships, growth strategies, competitive intel, local trends, and core product strategies. - Leads and drives business development activities including lead generation, value analysis, needs assessment, deal management, product packaging, competitive positioning, demonstrations, proposal preparation and delivery, and contract development. - Responsible for the development of new health insurance-related products to meet customer demand and/or supplement revenue to the Health Plan for purpose of lowering cost of insurance for purchaser. - Targets sales opportunities by leveraging relationships through multiple channels at executive, existing clientele, community, and foundational levels. - Employs consultative and strategic account leadership to develop product expansion, new market development and retention strategies, including contract renewal. - Responsible for measuring and relaying impact and value, including ROI (return on investment), cost avoidance, population health management, and member wellness to the Heath Plan's senior leadership. - Develops and execute client plans to grow the portfolio via additional lines of business, cross-sell of product lines, upselling, and driving member growth. Drives increased utilization across all lines of business. - Exhibits thought leadership and deep understanding of the Health Plans landscape, including cost containment strategies, engagement, utilization, client requirements, market drivers, and buying cycles. - Oversees all complex internal and external interactions related to the clients, ensuring the best interest of the client and Health Plan. - Identifies areas where the Health Plan can increase its presence, including but not limited to potential partnerships, new markets, and/or methods to enhance efficiency within the organization's sales and marketing departments. In collaboration with internal stakeholders, provides recommendations based on market research and client/customer profiles, to expand market reach. - Collaborates with internal stakeholders on purchaser needs. Creates tailored solutions to meet purchaser needs, while maximizing opportunities for additional revenue and volume generation. - Responsible for projects in the areas of strategy and corporate development, as required. Creates scalable processes for project implementation and team accountability as appropriate. Leads the coordination of appropriate resources to respond to purchaser's informal and formal inquiries. - Acts as a trusted advisor regarding health-related offerings to purchasers and internal stakeholders. - Provides leadership, coaching, and/or mentoring to a subordinate group. May act as a lead or a functional supervisor. - Serves as subject matter expert, leading the sales function. Relies on comprehensive knowledge across multiple disciplines (reinsurance, risk management, contracting, financial arrangements, ERISA law, benefit design regulatory oversight, required plan documents for external, self-funded employers' health plans, etc.) to resolve complex problems. - Designs and delivers curriculum aimed at educating on foundations of insurance (ex: funding arrangements, regulatory issues, products). Builds competencies, provides ongoing education, and has the responsibility to ensure staff remain competent. - Responsible for creation and development of new programs intended to drive consumers uptake of the Health Plan. Possible programs include designated provider for workers compensation, pathways to self-funding for employers, and positioning of white-labeled PBM product for named accounts. - Development of new health insurance-related products to meet customer demand and/or supplement revenue to Health Plan for purpose of lowering cost of insurance for purchaser. - Performs other duties and responsibilities as assigned. Qualifications - Education: Bachelor's Degree or experience in lieu of degree. - Experience: 8 years' experience (health insurance industry). - Licenses/Certifications: Insurance Producers License in Idaho.