- 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...and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Madison, WI)
- …materials, internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and ... Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other… more
- CVS Health (Madison, WI)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- 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
- Humana (Madison, WI)
- …part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice ... appeals. The Corporate Medical Director works on problems of diverse scope and...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Humana (Madison, WI)
- … compliance on this complex and expanding areas. In addition, this role supports compliance of Medicare bid filings and allows you to see the overall end ... us put health first** The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight...to end bid process at a leading Medicare Advantage organization. This is a great role for… 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 ... reviewing home health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether… 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 group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed ... **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The … more
- Humana (Madison, WI)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +… more