341 jobs found in milwaukee

About the Role We provide innovative solutions that optimize performance in the short term and prepare for future strategic, operational, financial and legal challenges unique to our healthcare and life sciences clients. What You'll Do Exhibit personal leadership skill and ability. Provide project management and client management expertise as needed. Use clinical expertise to extract pertinent data for initiative based analysis. Compile data along with information gathered from key interviews to formulate an assessment document. Develop proposals and pitch material Develop business cases Deliver a quality work product within established time frames. Capable of developing rapport and credibility with all client stakeholders Assist in and in some cases lead efforts to generate revenue and originate new client relationships Mentor and develop junior staff Refine and develop methodologies and outputs Basic Qualifications Minimum of 8 years...

Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements Monitor appeals and grievances and provide senior management with monthly reporting on trends Ensure that all members and provider grievances are processed and investigated according to contract requirements Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals Integrate federal and state law changes into company's regulatory system related to grievance and appeals Recommend solutions and works with department and company staff to ensure...

Position Purpose: Update and maintain provider computer records for assigned sites Add, change and terminate new or existing provider records in the medical information system Schedule monthly provider verifications regarding provider enrollment specifications and demographics Oversee Medicare and Medicaid provider directory process including achieving and maintaining compliance with the State and CMS with regards to the Medicare and Medicaid directory Maintain internal demographics database utilizing information from provider's offices and monthly reports Gather data from the assigned State to monitor current panel of providers and any possible sanctions Assist various cross-functional departments in monitoring and auditing files, systems, and databases for accuracy Education/Experience: High school diploma or equivalent. 1+ years of provider data or network administration experience, preferably in managed care. Knowledge of the provider subsystems and...

Position Purpose : Responsible for conducting a variety of healthcare audits for the Medicare and Medicaid clinical team members. Conduct auditing of work performed by clinical staff and present findings and recommendation for areas of improvement to management Develop and maintain complex audit processes and audit tools related to authorizations, appeals, quality, star measurement reviews, inter-rater reliability and data entry Conduct training needs analyses to determine specific training needs for clinical staff Research, analyze, and recommend external training programs Maintain records of auditing activities and employee progress Assist with revisions to Policy and Procedure and/or work process development Under minimal supervision responsible for all aspects of difficult projects that are broad in nature and require originality and/or ingenuity Education/Experience: Associate's or Bachelor's degree in Nursing or equivalent experience. 4+ years of nursing,...

Bayer's Cardiorenal division is undergoing an impressive growth trajectory and significant R&D investment. Bayer is committed to improving cardiorenal health both in the US and globally with currently available products and products in development, including investigational treatments for Chronic Kidney Disease (CKD), heart failure with reduced and preserved ejection fraction, and renal anemia. Given the profound burden of CKD in Type 2 Diabetes (T2D), Bayer is making significant investments in developing a treatment option for the disease. YOUR TASKS AND RESPONSIBILITIES The primary responsibilities of this residence-based role, Cardiorenal Sales Specialist - Milwaukee, WI, are to: Build and develop professional relationships with (but not limited to) cardiology, nephrology, endocrinology, primary care and pharmacy staff, within assigned customers; Drive appropriate utilization of approved cardiovascular (CV) products; Work closely with other Bayer commercial...

Location: Denver, CO Job Facts: This is an exciting time to join Roche Support Network. If you are passionate for problem solving then this is the position for you! As a research-focused healthcare company, Roche discovers, develops and provides innovative diagnostics and therapeutic products and services that deliver significant benefits to patients and healthcare professionals - from early detection and prevention of diseases to diagnostics, treatment and treatment monitoring. We encourage and support your development in areas of your interest which will prepare you for the next level in your career path. We know that people are responsible for our success and we value our employees. Our commitment is to create a work environment where feeling valued, respected, and empowered is a daily experience. The Opportunity: The Roche Support Network group is committed to providing industry-defining support to its customers. As a Field Engineering Specialist, you will have the...