- Humana (Madison, WI)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- CVS Health (Madison, WI)
- …Member Services teams, as well as management of tools, etc. Ensure compliance with state mandated processes and procedures by maintaining contractual oversight of ... projects based on resource requirements. **Required Qualifications** Strong knowledge of Medicaid to include experience with the Member Call Centers Experience with… more
- CenterWell (Madison, WI)
- …a part of our caring community and help us put health first** The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care, ... drug strategies to mitigate cost trend and improve health outcomes. The Medicaid Drug Strategy Pharmacist Lead work assignments involve moderately complex to complex… more
- Molina Healthcare (Milwaukee, WI)
- …should be knowledgeable of and have experience with South Carolina Medicaid **Job Summary** Provides subject matter expertise and responsibility for oversight, ... goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits &… more
- CVS Health (Madison, WI)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance , Medicaid Investigations, MCO Medicaid FWA ... Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role...Investigation or Medicaid / Medicare / Commercial Compliance role + Strong verbal and written communication skills.… more
- Prime Therapeutics (Madison, WI)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Molina Healthcare (Madison, WI)
- …goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits & ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Molina Healthcare (Milwaukee, WI)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination,… more
- Walworth County (Elkhorn, WI)
- …the consumer's treatment/recovery plan and that the documentation is complete in compliance with all Medicaid , state and program requirements. Communicate to ... Behavioral Health Community Case Manager (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/5039733) Apply Behavioral Health Community… more
- Molina Healthcare (Milwaukee, WI)
- **Job Summary:** The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid , Medicare, and ... protocols to support efficient and compliant subrogation operations across Medicaid , Medicare, and Marketplace populations. + Collaborate with legal, claims,… more