- Humana (Madison, WI)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- 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
- Prime Therapeutics (Madison, WI)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs **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
- 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
- Elevance Health (Waukesha, WI)
- **Medical Director - Medicare ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Molina Healthcare (Kenosha, WI)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more