• Member Grievances Specialist

    Molina Healthcare (WI)
    **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
    Molina Healthcare (09/06/25)
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  • Senior Specialist , Member

    Molina Healthcare (WI)
    **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member ... intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused… more
    Molina Healthcare (07/31/25)
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  • Sr Specialist , Member Engagement…

    Molina Healthcare (Kenosha, WI)
    **Job Description** **Job Summary** Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member ... involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member more
    Molina Healthcare (08/08/25)
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  • Supervisor, Member Outreach / MCO Training…

    Molina Healthcare (Milwaukee, WI)
    Molina Healthcare is hiring a Supervisor, Member Outreach, Training Specialist . This remote role will have a focus on spearheading, facilitating much of the ... Managed Care background and/or is familiar with Medicare and Medicaid . + Process based, + Able to build forms...operations and supervision of staff with adherence to the member outreach program. Assist with implementation of interventions to… more
    Molina Healthcare (09/04/25)
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  • Associate Specialist , Appeals & Grievances

    Molina Healthcare (Milwaukee, WI)
    **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) ... standards and requirements established by the Centers for Medicare and Medicaid . **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal into… more
    Molina Healthcare (08/30/25)
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  • Clinical Support Specialist

    Elevance Health (Waukesha, WI)
    **CareBridge Health** is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in ... an accommodation is granted as required by law._ The **Clinical Support Specialist ** is responsible for providing day-to-day support to care team (including RNs,… more
    Elevance Health (09/09/25)
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  • Home Medical Equipment Specialist I

    Mayo Clinic (La Crosse, WI)
    …Competitive retirement package to secure your future. **Responsibilities** The HME Specialist I position is the first of multiple career opportunities within ... interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps....able to work independently as needed. Knowledge of Medicare, Medicaid and/or private insurance billed preferred with attention to… more
    Mayo Clinic (08/08/25)
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  • Medicare Customer Service Specialist

    Molina Healthcare (Kenosha, WI)
    Molina Healthcare is hiring for its outbound Medicare Member Engagement team. Candidates who are Bilingual in either Mandarin or Cantonese are highly desired. This ... will work 8am to 430pm Pacific Standard Time, Monday through Friday. Medicare Member Engagement Specialists will make outbound welcome calls to our members along… more
    Molina Healthcare (08/31/25)
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  • Care Coach (Transition/Custodial Prevention)

    Humana (Beloit, WI)
    …and help us put health first** The Care Coach 2 (Transition/Custodial Prevention Specialist ) assesses and evaluates member needs and requirements to achieve ... of moderate complexity. The Care Coach 2 (Transition/Custodial Prevention Specialist ) will meet members in the field at home,...at home, Nursing Facility (NF) or location of the member 's choice, spending quality time assessing their goals, needs… more
    Humana (09/08/25)
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  • Delaware Valley ACO Fellowship

    Humana (Madison, WI)
    …accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and ... the opportunity to become acquainted with each of our member hospitals. (For any internals, this will be a...Board + Leads strategic planning efforts to develop a specialist network within the ACO + Develops a health… more
    Humana (07/30/25)
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