- CenterWell (Madison, WI)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Marshfield Clinic (Marshfield, WI)
- …Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened ... Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG ( Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related… more
- Molina Healthcare (WI)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- CenterWell (Madison, WI)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Evolent (Madison, WI)
- …to find the most valuable defects. The IQA reports to a associate director or a manager . One or many IQAs may be engaged in any testing effort **What You Will Be ... risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department...Good knowledge US Healthcare - Payer side, Knowledge of Medicare , Medicaid, Commercial Plans and understanding on claims workflow,… more
- Highmark Health (Madison, WI)
- …with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts ... system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare… more
- Fresenius Medical Center (Milwaukee, WI)
- …nurse in accordance with organization policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal ... ongoing performance of other PCT's. + Collaborates with the Clinical Manager and Education Coordinator in driving organization quality standards through education… more
- Marshfield Clinic (Marshfield, WI)
- …Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened ... activities. This individual will work collaboratively with the Volunteer Services Manager to coordinate various volunteer efforts and recognition, promotion of the… more
- Fresenius Medical Center (Fitchburg, WI)
- …nurse in accordance with FMCNA policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal agencies. ... ensure ongoing performance of other PCT's. + Collaborates with the Clinical Manager and Education Coordinator in driving FMS quality standards through education… more
- Molina Healthcare (Green Bay, WI)
- …that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution. + Maintains a minimal caseload as determined ... staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and...with staff and identify opportunities for improved quality and compliance . + Acts as liaison to both internal and… more