- CVS Health (Madison, WI)
- …**Work Schedule: Start times between 7:50 am and 11:45 am EST** The Worklife Resource Consultant is part of the Worklife Team and provides education about community ... resources, resource needs assessment, and community and/or national referrals to a variety of customers for a variety of needs including childcare, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation and… more
- Humana (Madison, WI)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... analysis of situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director's work… more
- Molina Healthcare (Madison, WI)
- **Job Description** **Job Summary** Provides leadership to the Medicare Duals team and plays a critical role in advancing the Medicare Integrated Duals segment ... strategic priorities. Develops and executes Medicare strategies, including state-specific and product-specific growth initiatives. Leads high-priority projects… more
- Good Samaritan (WI)
- …and support to all operating segments across Sanford. Responsible to review Medicare /Medicaid documentation to assist nursing centers in completing minimum data set ... (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement. Works with executive leadership, administrators, and facility staff in… more
- Humana (Madison, WI)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Understands… more
- CVS Health (Madison, WI)
- …Tracking Module (CTM) Senior Coordinator, you will be part of the Medicare Complaints Tracking Module (CTM) Team, responsible for researching and resolving ... complaints received via the Centers for Medicaid and Medicare Services (CMS). In this role, you will manage...In this role, you will manage a queue of Medicare complaints. These complaints can include various issues ranging… more
- Humana (Madison, WI)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...HR. DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and… more
- Humana (Madison, WI)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years....over 23 years. CarePlus strives to help people with Medicare , or both Medicare and Medicaid, achieve… more
- Humana (Madison, WI)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looking for long-term improvements of encounter submission processes. Begins to… more
- Humana (Madison, WI)
- …medical review by physician or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of high quality, appropriate, and ... to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the Medicare … more