- Humana (Madison, WI)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse scope and...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Public Consulting Group (Madison, WI)
- …learn more, visit www.publicconsultinggroup.com . Duties & Responsibilities . Prepare Medicare and/or Medicaid cost reports for ambulance providers. . Reconcile ... general ledger and accounting assistance to financial staff. . Ensure compliance with accounting principles and procedures. . Recommend accounting process… more
- CVS Health (Madison, WI)
- …lifecycle management of Aetna's integrated products (HIDE/FIDE) that serve Medicare Advantage populations, including Dual-Eligible Special Needs Plans (D-SNP). This ... care objectives. Working cross-functionally with Duals Center of Excellence, clinical, compliance , analytics and network teams, the Senior Manager drives innovation… more
- Humana (Madison, WI)
- …clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Madison, WI)
- …ensuring compliance with governmental requirements for clinics across both federal and state requirements. The work assignments involve moderately complex to ... and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic… more
- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage… more
- Humana (Madison, WI)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (Madison, WI)
- …clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid, and Medicare ... level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Madison, WI)
- …of our caring community and help us put health first** The Senior Compliance Professional ensures compliance with governmental requirements. The Senior ... or data requires an in-depth evaluation of variable factors. The Senior Compliance Professional develops and implements compliance policies and procedures.… more
- Humana (Madison, WI)
- …and help us put health first** Humana Healthy Horizons is seeking a Senior Compliance Professional to ensure compliance as they relate to Medicaid State ... reporting. The Senior Compliance Professional work assignments involve moderately complex to complex...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more