- Humana (Madison, WI)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Molina Healthcare (Kenosha, WI)
- …the organization and outsourced vendor work. The Sr. Analyst providers peer level support to Analysts in the department through training and guidance on audits and ... federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At the direction of… more
- Molina Healthcare (Milwaukee, WI)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... maintain risk score models. + Generate and distribute routine reports to support risk adjustment calculations, pricing, and financial reporting. + Extract and… more
- Molina Healthcare (Kenosha, WI)
- …pharmacy technicians, pharmacy service representatives, and/or pharmacy internal monitors who support processes involved with the review of non-formulary drugs or ... speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is… more
- Molina Healthcare (Madison, WI)
- …ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of ... License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare… more
- Molina Healthcare (WI)
- …architecting and maintaining robust, scalable, and secure data pipelines that support critical decision-making across the organization. This position requires deep ... * Architect and implement scalable, high-performance Big Data solutions that support structured and unstructured data from diverse sources. * Build and… more
- Molina Healthcare (Madison, WI)
- …areas of responsibility + Provides oversight analyses of demographic data to support accurate Network Adequacy Reporting and Directory development. + Manage multiple ... + Ability and willingness to take a hands-on execution role where required to support client needs and team development + Highly organized with an ability to work… more
- Prime Therapeutics (Madison, WI)
- …algorithms based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal ... Operations, IT, Quality, and Compliance as needed for program support . + Client support , including but not limited to, responding to inquiries, customization… more
- CenterWell (Madison, WI)
- …Owner to lead the delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
- Molina Healthcare (Green Bay, WI)
- …to families and individuals who qualify for government-sponsored programs, including Medicaid, Medicare , Managed Long-Term Services and Support (MLTSS) and - in ... years of management experience. + Working knowledge of Medicaid and Medicare products. **Preferred Education:** + Master's Degree in Business, Health Administration,… more