- Molina Healthcare (Racine, WI)
- …and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** ... + 3 - 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Experience with Databricks… more
- Molina Healthcare (Green Bay, WI)
- …**Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, ... available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment is not required. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze risk score… more
- Humana (Madison, WI)
- …reference sources. Medical Directors will learn Medicare, Medicare Advantage, and Medicaid requirements and will understand how to operationalize this knowledge in ... professionals are in agreement with national guidelines, CMS and state Medicaid requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Prime Therapeutics (Madison, WI)
- …oversees contracting, rate generation, reporting, and deliverables for State Medicaid supplemental rebate programs. This role collaborates with internal departments ... and external partners, including State Medicaid Programs and pharmaceutical manufacturers, to ensure strategic objectives and contractual obligations are met. This… more
- Humana (Madison, WI)
- …health first** The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementations, from start to finish, so that it is ... internal stakeholders. The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementation, from start to finish, so that it is… more
- Humana (Madison, WI)
- …conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid , and Medicare Advantage requirements and will understand how to ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/… more
- Molina Healthcare (Madison, WI)
- …with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other ... in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid , National Committee...for Medicare and Medicaid Services (CMS), state Medicaid , National Committee for Quality Assurance (NCQA) and/or other… more
- WestCare Foundation (Milwaukee, WI)
- …+ Maintain proper balance regarding source of payment (fee for service, Medicaid , public, private, and third-party payers) + Responsible for educating clients on ... on a timely basis. + Assist all clients with application process for Medicaid by assisting with completion of the application, addressing any questions or concerns… more
- Cognizant (Madison, WI)
- …with stakeholders to design solutions, troubleshoot issues, and ensure compliance with Medicaid and Medicare requirements. **In this role, you will:** + Analyze, ... fee tables, and policy administration. + Experience building solutions for Medicaid QNXT benefit configuration matrix. + Strong troubleshooting skills for claim… more
- Humana (Madison, WI)
- …Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care ... formulary management and clinical programming + Represents Humana at all Pharmacy Medicaid meetings including those with the Michigan Department of Health and Human… more