- Molina Healthcare (Milwaukee, WI)
- **Job Description** **Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and ... the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations. **Knowledge/Skills/Abilities**… more
- Molina Healthcare (Madison, WI)
- …of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Molina Healthcare (Madison, WI)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... vendor performance involving onshore and offshore resources, monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality… more
- Molina Healthcare (Kenosha, WI)
- …business areas and owners to ensure processes and reporting exists to demonstrate compliance to regulatory requirements. * Supports Manager and Director with ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more
- Molina Healthcare (Kenosha, WI)
- …speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is ... leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. + Responsible for key… more
- Molina Healthcare (Madison, WI)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Humana (Madison, WI)
- …develop engagement best practices, and design clinical solutions for members who have Medicare and Medicaid. The Lead Product Manager partners across various ... our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Green Bay, WI)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Humana (Madison, WI)
- …team. **Preferred Qualifications:** + Master's Degree + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional ... of our caring community and help us put health first** The Field Marketing Manager is responsible for leading and managing a high-performing team focused on driving… more
- Humana (Madison, WI)
- …of the business there is limited day to day flexibility in care manager 's schedule. **Duties:** + Telephonically assess Medicare , Medicaid, and/or and Group ... community and help us put health first** The Care Manager , Telephonic Nurse 2 employs a variety of strategies,...advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The… more