• Medical Director Aetna Duals Center of Excellence

    CVS Health (Madison, WI)
    …years of clinical practice experience. Two (2) + years of experience in managed care ( Medicare and/or Medicaid ) MD or DO; Board certification in an ABMS or AOA ... one state where we have an Integrated plan. Experience with managed care ( Medicare and Medicaid ) utilization review preferred. **Education** MD (Doctor of… more
    CVS Health (11/13/25)
    - Related Jobs
  • Specialist, Appeals & Grievances

    Molina Healthcare (WI)
    …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive ... including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and… more
    Molina Healthcare (11/07/25)
    - Related Jobs
  • Physician Assistant or Nurse Practitioner…

    Marshfield Clinic (Rice Lake, WI)
    …have been or be excluded from participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must ... be excluded from participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must immediately… more
    Marshfield Clinic (10/24/25)
    - Related Jobs
  • RN MDS Coordinator

    Ascension Health (Brookfield, WI)
    …regulations for long-term care, such as those for certification, licensure and accreditation, Medicare , and state Medicaid . + Participate in all aspects of the ... hire. **Additional Preferences** + Specialized knowledge with MDS 3.0, and current Medicare and Medicaid billing regulations preferred. + Resident Assessment… more
    Ascension Health (10/01/25)
    - Related Jobs
  • Lead Investigator, Special Investigative…

    Molina Healthcare (Racine, WI)
    …according to the SIU's standards. Position must have thorough knowledge of Medicaid / Medicare /Marketplace health coverage audit policies and be able to apply ... data from all types of healthcare providers that bill Medicaid / Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure investigators are managing their… more
    Molina Healthcare (11/21/25)
    - Related Jobs
  • PCO Medical Director - UM - Part Time (Hourly)

    CenterWell (Madison, WI)
    …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
    CenterWell (11/06/25)
    - Related Jobs
  • Business Support Coordinator

    Humana (Eau Claire, 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
    Humana (11/27/25)
    - Related Jobs
  • Lead Data Scientist

    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
    Humana (11/27/25)
    - Related Jobs
  • UM Behavioral Health Nurse

    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
    Humana (11/27/25)
    - Related Jobs
  • Senior Compliance Professional

    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
    Humana (11/26/25)
    - Related Jobs