- Molina Healthcare (Racine, WI)
- …the benefits, operations, communication, reporting, and data exchange of the Medicare /MMP product in support of strategic and corporate business objectives. Support ... for all Medicare lines of business the annual Medicare ...Marketing Guidelines, initiating HPMS submission of materials for CMS review when required. Provides oversight and update of the… more
- Walworth County (Elkhorn, WI)
- Medicare Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/3201106) Apply Medicare Specialist (HHS) Salary $18.70 Hourly ... Equal Opportunity Employer Position Summary This position is responsible for assisting Medicare beneficiaries with enrollment issues regarding Medicare Part D, … more
- St. George Tanaq Corporation (Madison, WI)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare ... 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 (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
- Molina Healthcare (Milwaukee, WI)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate...to practice and free of sanctions from Medicaid or Medicare . **PR** **E** **FE** **R** **RED ED** **U** **C**… more
- Molina Healthcare (Kenosha, WI)
- …quality. **Job Duties** + Monitor and Evaluate Calls: Listen to and review Concierge call interactions to assess agent performance against quality standards, ... members, and manager. + Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate or bachelor's degree in social work, Human… more
- Elevance Health (Waukesha, WI)
- ** Medicare Medical Director** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
- 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 (Madison, WI)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Molina Healthcare (Racine, WI)
- …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more