- Humana (Madison, WI)
- …+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization + Proficient utilizing electronic medical record ... caring community and help us put health first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration … more
- Cardinal Health (Madison, WI)
- …and projects assigned. + Stay up to date on insurance policies, managed care guidelines and relevant healthcare regulations affecting authorization processes. ... independently with minimal supervision. + Strong organizational skills. + Understanding of managed care contracts and fee schedules, including Medicare and… more
- Cardinal Health (Madison, WI)
- …independently with minimal supervision. + Strong organizational skills. + Understanding of managed care contracts and fee schedules, including Medicare and ... Coordinator , Benefits Eligibility and Authorization **_What Benefits Eligibility...that may need to happen to not delay patient care . + Complete any pre-service appeals to obtain paying… more
- Cardinal Health (Madison, WI)
- …management preferred. + Familiarity with Medicare, Medicaid, commercial insurance plans, and managed care preferred. + Proficiency in billing software (eg ... and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the… more
- Sedgwick (Madison, WI)
- …appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact. + Ensures claims ... Fortune Best Workplaces in Financial Services & Insurance Specialty Operations Coordinator **PRIMARY PURPOSE** : To analyze low- and mid-level workers compensation… more
- Highmark Health (Madison, WI)
- …degree + Pharmacy technician certification certificate + Experience working in a managed care medication formulary management environment + Working knowledge of ... reviewer in monitoring and ensuring adherence to the health plan 's state and federal multiple drug benefit design offerings....to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and… more
- Humana (Monroe, WI)
- …to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity(R) which ... us put health first** Humana is seeking an RN Care Manager (Health & Wellness Coordinator ) to...development and ongoing review and coordination of the member's plan of care . + Take the lead… more
- Elevance Health (Darlington, WI)
- …is granted as required by law._ Anthem is very excited to be a managed care organization in western/southwestern Wisconsin and Milwaukee County to offer the ... **LTSS Service Coordinator - RN Clinician (RN Case Manager)** **$5,000...of licensure, develops, monitors, evaluates, and revises the member's care plan to meet the member's needs,… more
- Option Care Health (Madison, WI)
- …IG to include clinical, market, and payer dynamics + Knowledge of reimbursement, managed care , and marketing **Basic Qualifications** + Proven record of ... clinicians as well as medical office staff (ie biologics coordinator ) to appropriately promote Option Care Health...Maintain a call average as outlined in the sales plan , defined as face-to-face interactions with healthcare providers, focusing… more
- CVS Health (WI)
- …clinical case management or crisis intervention as appropriate. - Coordinates and implements assigned care plan activities and monitors care plan ... **Preferred Qualifications** - Case Management and discharge planning experience. - Managed Care experience. **Education** Bachelor's degree or non-licensed… more
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