• Manager , Special Investigation

    CVS Health (Madison, WI)
    …years of leadership experience + A minimum 3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / ... lost funds, and to comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the planning and execution of… more
    CVS Health (08/01/25)
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  • HS/Lhcc Manager - Administrative Services…

    Walworth County (Elkhorn, WI)
    …for the Comprehensive Community Services (CCS), Case Management (CM) and Wisconsin Medicaid Cost Reporting (WIMCR) program services that are consistent with ... HS/LHCC Manager - Administrative Services (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/5028505) Apply  HS/LHCC Manager -… more
    Walworth County (08/01/25)
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  • Program Manager , HCS

    Molina Healthcare (Racine, WI)
    …of external vendors. + Focuses on process improvement, organizational change management, program management and other processes relative to the business. + Serves as ... management, case management, care transition and/or disease management. + Minimum 2 years of healthcare or health plan supervisory or managerial experience,… more
    Molina Healthcare (08/02/25)
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  • Family Care Partnership- RN Care Manager

    Humana (Kenosha, WI)
    …disabilities, or older adults in a health care setting. + Case Manager Certification. + General knowledge of Medicaid and Medicare benefits. ... put health first** Humana/iCare is seeking an RN Care Manager to join the team in the Family Care...join the team in the Family Care Partnership (FCP) program to provide services to members in Racine/Kenosha counties.… more
    Humana (07/30/25)
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  • Manager -Clinical PSN

    Centers for Independence (Milwaukee, WI)
    ** Manager -Clinical PSN** **Job Details** **Job Location** MCFI Main Campus - Milwaukee, WI **Position Type** Full Time **Travel Percentage** Minimal; Less than 10% ... **Job Shift** Day **Description** **Job Purpose:** The clinical manager is responsible for organizing and directing the daily operations of the Pediatric Skilled… more
    Centers for Independence (07/23/25)
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  • Nurse Manager - Hospital, Labor & Delivery

    Marshfield Clinic (Weston, WI)
    …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... most exciting missions in the world!** **Job Title:** Nurse Manager - Hospital, Labor & Delivery **Cost Center:** 301691326...of hire. " _*Nurse managers hired prior to May 2 , 2022 may be grandfathered from meeting the new… more
    Marshfield Clinic (08/01/25)
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  • Special Investigation Unit (SIU) Coding Review…

    CVS Health (Madison, WI)
    …it all with heart, each and every day. The Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit ... reviews for medical, behavioral, transportation, and other healthcare providers. The CPC Manager will be responsible for guiding the team in determining correct… more
    CVS Health (08/08/25)
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  • Specialty Account Manager -Krystexxa…

    Amgen (Milwaukee, WI)
    …sales, and performing total territory account management. The Specialty Account Manager , Nephrology (NSAM) is responsible for representing Amgen products to ... verification, prior-authorization, billing, coding, claims, and appeals/denials), Medicare and Medicaid rules and regulations, and OSHA and HIPAA compliance as… more
    Amgen (07/25/25)
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  • Manager , Provider Engagement (Remote…

    Molina Healthcare (Madison, WI)
    **Job Description** **Job Summary** The Manager , Provider Engagement establishes strategies and operational directions for risk adjustment and quality improvement. ... key performance indicators. + Ensures each Tier 1, Tier 2 and Tier 3 provider has quality & risk...challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health… more
    Molina Healthcare (06/22/25)
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  • Clinical Account Manager - Georgia PDL…

    Prime Therapeutics (Madison, WI)
    …passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** Innovative business ... with pharmacy department or designated customer contacts. + Directs operations account manager in resolving customer service issues and actions supportive of the… more
    Prime Therapeutics (07/24/25)
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