- 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
- Evolent (Madison, WI)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Aveanna Healthcare (Brookfield, WI)
- …home healthcare. You'll be the go-to for clinical oversight, documentation review , and client support-ensuring our standards stay top-notch while optimizing ... + Collaborate with field staff and leadership to coordinate services and review clinical documentation + Communicate with families, physicians, and other providers… more
- Prime Therapeutics (Madison, WI)
- …help ensure efficient and effective solutions are implemented + Perform and review detail plans to address complex compliance issues by identifying goals, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Datavant (Madison, WI)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Otsuka America Pharmaceutical Inc. (Madison, WI)
- …territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization ... in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially... & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in "Buy and Bill"… more
- Cardinal Health (Madison, WI)
- …about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while ... High School diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more