- Molina Healthcare (Milwaukee, WI)
- …oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School ... regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part D, Medicaid,… more
- Humana (Madison, WI)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...or similar pharmacy practice experience + Board Certified Pharmacotherapy Specialist (BCPS) + MBA, pharmacoeconomics or health outcomes training… more
- CVS Health (Madison, WI)
- …pre-certification, and predetermination of covered benefits in the commercial, Medicare , and Medicaid environment. This Wheelchair DME consultant provides subject ... and correct application of Aetna policies and practices for commercial, Medicare , and Medicaid environments. ◾Proactively use data analysis to identify opportunities… more
- Molina Healthcare (Green Bay, WI)
- …Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically ... appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret… more
- Molina Healthcare (Madison, WI)
- …compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... delegated groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality… more
- St Croix Hospice (Delavan, WI)
- …Additional Duties + Maintains knowledge of and compliance with current Medicare /Medicaid, state/federal rules and regulations for hospice services + Ensures ... compliance with the Medicare conditions of participation and other state regulations govern...nursing as required by State. + Certification in a specialist area preferred; (eg Hospice and Palliative Nursing (CHPN),… more
- Evolent (Madison, WI)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Marshfield Clinic (Eau Claire, WI)
- …(AMI), Certified Biomedical Electronics Technician (CBET), Certified Radiology Equipment Specialist (CRES), or Certified Laboratory Equipment Specialist (CLES) ... been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately… more
- Banner Health (WI)
- …and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health ... least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Certified… more
- Marshfield Clinic (Eau Claire, WI)
- …provided by the American Heart Association. Registered Invasive Cardiovascular Specialist (RCIS) or Registered Cardiac Electrophysiology Specialist (RCES) ... been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately… more