- Molina Healthcare (Kenosha, WI)
- …analytics. + Strong understanding of healthcare environments, including **Medicaid, Medicare , and Marketplace** member and provider engagement models. + Demonstrated ... success in implementing **AI-driven contact center and digital engagement initiatives** , including **Lightico, biometric authentication, and digital ID solutions.** + Financial management experience overseeing budgets, vendor contracts, and technology… more
- Marshfield Clinic (Marshfield, WI)
- …been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately ... notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program** **.** **Marshfield Clinic Health System is an Equal** **Opportunity/Affirmative** **Action employer.… more
- Molina Healthcare (Green Bay, WI)
- …to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. * Conduct varies surveys related to health assessments ... and member/provider satisfaction. * Accurately document pertinent details related to Member or Provider inquiries. * Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or… more
- Humana (Madison, WI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- Molina Healthcare (Racine, WI)
- …clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality ... referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy… more
- Molina Healthcare (Madison, WI)
- …Health or Healthcare. **Preferred Experience** 1 year of experience in Medicare and in Medicaid. **Preferred License, Certification, Association** + Certified ... Professional in Health Quality (CPHQ) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive… more
- Molina Healthcare (Racine, WI)
- …to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. * Provide exemplary customer service to customers including ... members, co-workers, vendors, providers, government agencies, business partners, and general public * Assists agents with questions and escalated contact center communication channels and across multiple states and/or products. Recognizes trends and patterns… more
- Molina Healthcare (Racine, WI)
- …to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work ... experience within the health care industry (ie, hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified… more
- Molina Healthcare (Green Bay, WI)
- …rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate/consult ... the health plans on the financial impact. * Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting * Ability to translate contract… more
- Molina Healthcare (Kenosha, WI)
- …provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday ... 8:00am- 5:00pm PST. This position included rotating weekends and holidays is required. Remote position **Essential Job Duties** * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and… more