- Molina Healthcare (Green Bay, WI)
- …the product choices available to them, the enrollment process (eligibility requirements, Medicare review /approval of their enrollment application, timing of ID ... for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved… more
- Humana (Madison, WI)
- …help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or… more
- 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
- Good Samaritan (WI)
- …guidance and support to all operating segments across Sanford. Responsible to review Medicare /Medicaid documentation to assist nursing centers in completing ... minimum data set (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement. Works with executive leadership, administrators, and… more
- CVS Health (Madison, WI)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...in internal monitoring audits and coaching feedback sessions to review schedule adherence, quality, selling skills and compliance. +… more
- Sedgwick (Madison, WI)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, ... specialized document review , and analysis and interpretation of interventions for the...analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We… more
- Molina Healthcare (Racine, WI)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… 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 (Madison, WI)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and...for additional vendor funding as required. + Oversee the review , reconciliation, and approval of invoices for payment of… more
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