- Molina Healthcare (Green Bay, WI)
- …SummaryProvides subject matter expertise and leadership to healthcare services function - providing support for project/ program /process design, execution, ... into functional requirements. * Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality… more
- Molina Healthcare (Green Bay, WI)
- …Summary** Provides subject matter expertise and leadership to healthcare services function - providing support for project/ program /process design, execution, ... into functional requirements. + Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality… more
- Molina Healthcare (Green Bay, WI)
- **Job Description** **Job Summary** The In-Home Assessment Program Manager is part of our innovative Risk Adjustment department to assist our diverse team of ... medical loss ratio (MLR) targets. In conjunction with the Manager of the In-Home Assessment Program , this...Programs, Market & Segment Leaders, health plan teams, member services , provider services , external vendors, actuary, and… more
- Molina Healthcare (Green Bay, WI)
- **JOB DESCRIPTION** Job Summary: The AI Program Manager serves as a strategic leader driving the execution of AI initiatives to deliver meaningful business ... process improvement and organizational change management to operationalize the AI program vision. This includes end-to-end program planning (estimating,… more
- Molina Healthcare (Green Bay, WI)
- …Job Summary Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team ... processes. * Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate… more
- Molina Healthcare (Green Bay, WI)
- …including behavioral health, long-term care, and population health-related education and services for members with high-need potential. Strives to ensure member ... and written communication skills. * Microsoft Office suite/applicable software program (s) proficiency. Preferred Qualifications **LVN is preferred for this role.**… more
- Molina Healthcare (Green Bay, WI)
- …standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team responsible for the ... appeals and denials. * Previous experience leading projects. * Strong customer service experience. * Strong organizational and time management skills; ability to… more
- Walgreens (De Pere, WI)
- …when using the pharmacy. Enhances customer experience by increasing focus on healthcare services . **Operations** + Responsible for assisting pharmacist in the ... allowed by law). Under the supervision of a pharmacist assists with healthcare service offerings including administering vaccines, health screenings, and any… more
- Humana (Appleton, WI)
- …first - for our teammates, our customers, and our company. Through our Humana insurance services , and our CenterWell healthcare services , we make it easier ... team, serving members in the Wisconsin Family Care (FC) program . In this dynamic role, you will collaborate closely...to thrive in their daily lives. As a Case Manager , you will provide comprehensive social service … more
- Actalent (Neenah, WI)
- Healthcare Clinical Study Specialist Job Description A Clinical Study Specialist is a professional who will coordinate and oversee clinical operations of research ... under the general supervision of the Principal Investigator or Clinical Research Manager responsible for the clinical studies. Responsibilities + Obtain and review… more
- Molina Healthcare (Green Bay, WI)
- …Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), ... business segment (ie Medicare, Marketplace, advanced imaging/central utilization management services ) in the development and execution of care management,… more
- Molina Healthcare (Green Bay, WI)
- …supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed ... Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified… more
- Genesis Healthcare (Green Bay, WI)
- …children at home and in school. With over 38 years of trusted service , our reach spans skilled nursing centers, assisted and independent living facilities, ... + **Support for New Grads:** Our Powerback Clinical Mentorship Program kicks off on day one, helping you learn...new way of delivering recovery, rehabilitation, respiratory, and wellness services to patients across the nation. We deliver an… more
- Molina Healthcare (Green Bay, WI)
- …Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified ... procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. +… more
- Molina Healthcare (Green Bay, WI)
- …Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified ... National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and… more
- Molina Healthcare (Green Bay, WI)
- …oversight and expertise related to behavioral health and chemical dependency services , and assists with implementation of integrated behavioral health care programs ... management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize… more
- Molina Healthcare (Green Bay, WI)
- …medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for ... Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program… more
- Compass Group, North America (Appleton, WI)
- …the next step in your career with TouchPoint as a Clinical Nutrition Manager ** **!** **Location** : Ascension NE Wisconsin St. Elizabeth Hospital - Appleton, WI ... largest employers of Dietitians in a variety of settings: + Hospitals and healthcare systems + Senior living communities + Schools and universities + Corporate… more
- Molina Healthcare (Green Bay, WI)
- …QUALIFICATIONS:** + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, ... and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, Overpayment… more
- Walmart (Green Bay, WI)
- …team is dedicated to providing comprehensive patient care and ensuring the highest standards of service . As a Pharmacy Manager , you will lead the team to success ... operations and leading people? Join Walmart as a Pharmacy Manager and lead our team of pharmacists and pharmacy...enforce, and provide direction and guidance on proper customer service approaches and techniques to ensure customer needs are… more