- Molina Healthcare (Madison, WI)
- …ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity ... delegated groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid , National Committee for Quality… 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. ... also lead the development of new products and services in Humana's Medicaid BH delivery model. **Position Responsibilities:** + Leads clinical and quality management… 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. ... of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA...role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the… 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. ... This role will support a few tools used within our Individual Medicare Advantage pricing and internal reporting process. This includes: + Helping make… 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. ... expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims… 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. ... coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills...role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside… more
- Prime Therapeutics (Madison, WI)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… 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. ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… 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. ... of Network Adequacy requirements and process optimization, primarily focusing on the Medicaid line of business, with a deep understanding of network build… 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. ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more