- Molina Healthcare (Madison, WI)
- …director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. + Reviews quality referred issues, ... license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public… more
- Prime Therapeutics (Madison, WI)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director, Pharm Trade Relations leads a team of directors ... Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as manufacturer and GPO negotiation,… more
- Humana (Madison, WI)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Prime Therapeutics (Madison, WI)
- …client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned **Education & Experience** + Bachelor's ... within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must...study, such as Juris Doctor + Medicare Part D, Medicaid , and/or Affordable Care Act knowledge and experience **Physical… more
- Marshfield Clinic (Weston, WI)
- …+ Certified Application Counselor designation through the Centers for Medicare and Medicaid Services within three months from the first fall training offered after ... + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services at time of hire. **Marshfield Clinic Health System is committed… more
- Baylor Scott & White Health (Madison, WI)
- …to ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends ... . Responds to inquiries and guidance requests utilizing applicable Medicare and Medicaid rules and regulations. Serves as a compliance resource to BSWH departments… more
- Baylor Scott & White Health (Madison, WI)
- …to ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends ... in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and entities on… more
- Molina Healthcare (Eau Claire, WI)
- …Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. The job ... + Completes contacts to verify screen results with IRIS Consultants, Medicaid Personal Care agencies, and verifies diagnosis information with physicians and… more
- Cognizant (Madison, WI)
- …Fee schedules, Service groups, etc. . Understand and build solutions for Medicaid - QNXT Benefit configuration matrix. . Conduct requirements discovery sessions with ... for right configuration by working with Business team . Familiarity with Medicaid and Medicare programs are minimum requirements. **Salary and Other Compensation:**… more
- Humana (Madison, WI)
- …clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate about contributing to ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more