- Prime Therapeutics (Madison, WI)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Intermountain Health (Madison, WI)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... optimization of reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and Hospital Acquired… more
- Molina Healthcare (Madison, WI)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Marshfield Clinic (Marshfield, WI)
- …for risk adjustment strategy and related revenue management for Sanford Health Plan's Medicare , Affordable Care Act and Medicaid business and reports to the Senior ... the accuracy of the coding, including education; retrospective and prospective review processes; and vendor contract management; accountability for preparation for… more
- Elevance Health (Waukesha, WI)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more
- Prime Therapeutics (Madison, WI)
- …related partner/customer relationships including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director, Pharm ... + Direct the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as… more
- Molina Healthcare (Green Bay, WI)
- …needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings ... processes and established guidelines; provides appropriate follow up on peer review findings + Identifies, defines and communicates opportunities for improvement to… more
- Humana (Madison, WI)
- …interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will ... and relationship builder, ensuring alignment with Humana's mission and Medicare Advantage goals. **Primary Responsibilities:** Clinical Engagement & Provider… more
- Marshfield Clinic (Weston, WI)
- …are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._ **Minimum ... months of hire. + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services within three months from the first fall training… more
- Prime Therapeutics (Madison, WI)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more