• Behavioral Health Medical Director…

    Humana (Madison, WI)
    …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
    Humana (08/09/25)
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  • Medical Director - National Medicare Team

    Humana (Madison, WI)
    …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
    Humana (08/13/25)
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  • Senior Clinical Policy Research Professional

    Humana (Madison, WI)
    …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
    Humana (08/15/25)
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  • Dispute Resolution Reviewer I

    St. George Tanaq Corporation (Madison, WI)
    …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, ... college or university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other related experience in… more
    St. George Tanaq Corporation (08/08/25)
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  • Mgr Medicare Part D Pharmacy Programs…

    Prime Therapeutics (Madison, WI)
    …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...$74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
    Prime Therapeutics (07/24/25)
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  • Director, Appeals & Grievances ( Medicare

    Molina Healthcare (Kenosha, WI)
    …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
    Molina Healthcare (07/18/25)
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  • Medicare Risk Adjustment Advanced Analytics…

    Elevance Health (Waukesha, WI)
    ** Medicare Risk Adjustment Advanced Analytics Consultant** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Consultant** is responsible for employing advanced… more
    Elevance Health (07/29/25)
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  • Medicare Sales Field Agent

    Humana (Milwaukee, WI)
    …our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales with the ability to ... as well as, visiting prospects in their homes. Our ** Medicare Sales Field Agents** sell individual health plan products...protection. Please be aware that applicants selected for leader review may be asked to provide their social security… more
    Humana (08/14/25)
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  • Specialist, Appeals & Grievances ( Medicare

    Molina Healthcare (WI)
    …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
    Molina Healthcare (06/26/25)
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  • R-381302 - Medical Director - Medicare

    Humana (Madison, WI)
    …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
    Humana (08/15/25)
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