- Molina Healthcare (Kenosha, WI)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
- Elevance Health (Waukesha, WI)
- …specific understanding in end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare / Medicaid regulatory policies regarding FFS and ... background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (ACA) rules. **Preferred… more
- CenterWell (Madison, WI)
- …delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform empowers associates to ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
- CenterWell (Madison, WI)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... volunteer time off, paid parental and caregiver leave), short-term and long -term disability, life insurance and many other opportunities. Application Deadline:… 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
- Marshfield Clinic (Beaver Dam, 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 ... all resident care and business decisions. Ensure the facilities operate in compliance with all local, state, and federal regulations. Interacts with residents,… more
- Molina Healthcare (Green Bay, WI)
- …an integrated delivery of care across the continuum, including behavioral health and long -term care, for members with high need potential. HCS staff work to ensure ... that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution. + Maintains a minimal caseload as determined… more
- Molina Healthcare (Kenosha, WI)
- …**Highly Qualified Candidates Will Have the Following Experience-** Digital Tag Manager Programs Salesforce Marketing Cloud Google or Adobe analytics (or similar) ... Google AdWords, Tag Manager systems, (Adobe or Google) CMS (content management system)...utilizing best practices to increase lead conversion + Ensure compliance with consumer protection laws (CAN-SPAM, TCPA, etc.) and… more
- Marshfield Clinic (Beaver Dam, 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 ... federal regulations in state and federal codes and Joint Commission and coordinates compliance . 12. Assumes overall accountability for the delivery of care in the… more
- Humana (Madison, WI)
- …comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root causes driving issues and developing solutions + ... researching and resolving provider reimbursement inquiries + Experience with Optum Rate Manager + Experience with Optum WebStrat or PSI applications + Experience… more