- Humana (Madison, WI)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… 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 ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization … more
- St Croix Hospice (Wausau, WI)
- …the state Nurse Practice Act and under the supervision of a collaborating physician . He/She provides hospice care through the evaluation and assessment of the health ... families and other healthcare practitioners. Under the supervision of a physician , the nurse practitioner visits patients, completes physical assessments, performs… more
- Molina Healthcare (Milwaukee, WI)
- …appeals and supporting market performance. Performance activities include physician auditing, training, and performance improvement activities. Additionally, they ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- Humana (Madison, WI)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Evolent (Madison, WI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** . Serve ... as the Physician match reviewer in Advanced Imaging cases, that do...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Madison, WI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will Be Doing:** + Serve ... as the Physician match reviewer in Imaging cases, that do not...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Marshfield Clinic (Eau Claire, WI)
- …**Job Title:** Locum Tenens Recruiter (Remote/Hybrid) **Cost Center:** 301081250 Physician and APC Recruitment **Scheduled Weekly Hours:** 40 **Employee Type:** ... Locum Tenens Recruiter is responsible for the recruitment of physician and APC locum and NonClass A positions ensures...for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to… more
- Cardinal Health (Madison, WI)
- …Summary** Senior executive leader responsible for leading all aspects of Navista's Physician Office's revenue cycle, managed care and value based care programs and ... responsibilities include optimizing the revenue cycle to create financial stability to physician offices, develop short and long term strategic plans for manage care… more
- Evolent (Madison, WI)
- …interacts with leadership and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as, aids and acts as ... the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
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