- Humana (Oshkosh, WI)
- …caring community and help us put health first** Humana is seeking an RN Care Manager (Health & Wellness Coordinator) to join the Inclusa team to serve members in the ... the member. + Partner with a social services care manager (also referred to as a Community Resource Coordinator)...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Aveanna Healthcare (Brookfield, WI)
- Home Health RN Clinical Manager 10K Sign On Bonus ApplyRefer a FriendBack Job Details Requisition #: 207255 Location: Brookfield, WI 53005 Category: Nursing Salary: ... orientation and ensure competence as a Preceptor and or ensure RN Case Manager /Preceptor resources are in place. Ensures that services are delivered according to… more
- Sanofi Group (Madison, WI)
- **Job Title:** Immune Hematology Manager **Location** : Remote, US / Minneapolis, MN / Madison, WI / Milwaukee, WI / Omaha, NE **About the job** The Immune ... Hematology Manager (IHM) is responsible for effectively applying promotional and...knowledge of the Managed Care, GPOs, Specialty Pharmacy, State Medicaid and Veterans Affairs selling and reimbursement environment for… more
- CVS Health (Madison, WI)
- …Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager . In this role, you will manage negotiations, conduct high-level reviews and ... yourself and others) skills **Required Qualifications** * Commercial, Medicare, and/or Medicaid knowledge * 5+ years related experience, proven and proficient… more
- Cardinal Health (Madison, WI)
- …the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff. **_What is expected ... fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding… more
- Datavant (Madison, WI)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Coding Data Integration, you will own the data strategy and ... and compliant onboarding and management of client data for MA, ACA, and Medicaid plans, ensuring HIPAA and CMS compliance + **Standard Data Specifications:** Develop… more
- Datavant (Madison, WI)
- …to realize our bold vision for healthcare. As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding projects. You will work ... CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid , Commercial RA, and HEDIS experience. + Familiarity with HIPAA patient privacy… more
- Molina Healthcare (Milwaukee, WI)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Molina Healthcare (Kenosha, WI)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in… 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 ... with coverage and escalates complicated issues to the billing manager and/or director. + Coordinate with the billing ...basis. + Assist all clients with application process for Medicaid by assisting with completion of the application, addressing… more