• Corporate Medical Director - Medicare Grievances…

    Humana (Madison, WI)
    …clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about contributing to an ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/05/25)
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  • Utilization Management Behavioral Health RN

    Humana (Madison, WI)
    …utilization management with ASAM knowledge + Health Plan experience + Previous Medicare/ Medicaid Experience a plus + Bilingual is a plus **Workstyle:** Remote work ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/04/25)
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  • Associate Actuary

    Humana (Madison, WI)
    …for all Humana Insurance lines of business, with a primary focus on Medicaid . The Associate Actuary, Valuation will also assist with the development of premium ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/04/25)
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  • Utilization Management Registered Nurse

    Humana (Madison, WI)
    …necessity and appropriateness of care + Health Plan experience + Previous Medicare/ Medicaid Experience a plus + Bilingual is a plus **Workstyle:** Remote work ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/04/25)
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  • Clinical Account Director Remote

    Prime Therapeutics (Madison, WI)
    …member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the client regarding ... experience + Knowledge of the applicable line of business (eg, Medicare, Medicaid , Exchange, Commercial, Employer Group) Every employee must understand, comply with… more
    Prime Therapeutics (09/03/25)
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  • Senior Financial Analytics Professional

    Humana (Madison, WI)
    …leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/03/25)
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  • OCM Consultant

    Public Consulting Group (Madison, WI)
    …communications, and training activities related to MEMS Modules, MMIS Core Solutions, Medicaid DSS/DW and SI. * Prepare change impact assessments, identify risks, ... equivalent experience required. * 5 years of previous OCM experience preferred. * Medicaid experience a plus. * Ability to understand both the service delivery… more
    Public Consulting Group (09/03/25)
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  • Bilingual Case Manager

    Cardinal Health (Madison, WI)
    …long and short-range changes in the reimbursement environment including Medicare, Medicaid , Managed Care, and Commercial medical and pharmacy plans while planning ... diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, preferred + Strong people… more
    Cardinal Health (09/03/25)
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  • Stars Program Delivery Lead - HEDIS Controlling…

    Humana (Madison, WI)
    …delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/03/25)
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  • Stars Program Delivery Senior Professional - HEDIS…

    Humana (Madison, WI)
    …delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. ​ **Equal… more
    Humana (09/03/25)
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