- Humana (Madison, WI)
- …needs for Medicaid -specific product lines. The Lead Actuary will serve as a project manager in addition to working on problems of diverse scope and ... Qualifications** + 5 years of experience within the managed Medicaid industry + 3 years of project ...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- CenterWell (Madison, WI)
- …a part of our caring community and help us put health first** The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care, ... drug strategies to mitigate cost trend and improve health outcomes. The Medicaid Drug Strategy Pharmacist Lead work assignments involve moderately complex to complex… more
- Prime Therapeutics (Madison, WI)
- …additional resource needs; collaborate with Business Systems Analyst Resource Lead or Resource Manager to determine work assignments within project + Educate and ... skills **Preferred Qualifications** + Previous Pharmacy Benefit Management (PBM) or healthcare experience with understanding of Medicare, Medicaid , the Exchanges… more
- Humana (Madison, WI)
- …of healthcare through AI excellence. We are seeking a dynamic and experienced Senior Project Manager to join our team (known internally as a Senior IT ... Project Manager ). The ideal candidate will have...create safe AI solutions that will revolutionize and improve healthcare experience and outcomes for our customers. Join our… more
- Datavant (Madison, WI)
- …to realize our bold vision for healthcare . As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding projects. You ... in health data exchange. Our vision is that every healthcare decision is powered by the right data, at...projects and ensure all parties remain on track with project requirements, deadlines, and schedules. **You will:** + Partner… more
- Molina Healthcare (Milwaukee, WI)
- …Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification. + Project Management Experience. + Familiarity with Medicaid -specific Scorable ... **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable… more
- Molina Healthcare (Madison, WI)
- …with other Core Ops areas of responsibilities) within Medicare and Medicaid . Role is predicated on building relationships with vendors, stakeholders, functional ... Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including contract… more
- Molina Healthcare (Kenosha, WI)
- …Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification. + Project Management Experience + Familiarity with Medicaid -specific Scorable ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Molina Healthcare (Milwaukee, WI)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Molina Healthcare (WI)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... Duties** + Acts as a lead specialist to provide project , program, and/or initiative related direction and guidance for...to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may… more