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Coordinate various administrative expense budget functions, including the annual company budget, Medicare SNP bid projections and multi year administrative expense projections for product proposals/renewals. Generate and distribute monthly actual vs. budget expense variance reports to department heads and ensure understanding of reports, reasons for variances, etc. Responsible for cost allocation
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The Sales Coordinator is responsible for coordinating all activities related to growing and retaining the Medicare Advantage enrollment. The primary responsibilities include providing assistance to the Sales & Marketing Manager and the Medicare Benefits Consultants. Prepare reports on a daily and monthly basis. The monthly reports feed into the Monthly Dashboard Report that the Sales Manager prepa
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This position provides case management and support to older adults in the Milwaukee County communities, assuring quality services are provided which are cost effective and monitoring the heath and safety of members. Complete the nursing portion of the comprehensive assessment and provide input to the members care accordingly. Conduct home visits and community visits to assure appropriate care and
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Perform duties to support optimized performance on key quality indicators including, but not limited to, HEDIS, 5 Star, Pay for Performance (P4P), satisfaction surveys, Annual Quality Reviews (AQR), and External Quality Reviews (EQR). Apply continuous quality improvement strategies across all business lines to improve the quality of i Care's Medicare, Medicaid, and Long Term Care programs. The QAP
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The Medicare Benefits Consultant is responsible for growing Medicare Advantage enrollment volume by targeting Medicare beneficiaries that have dual eligible status (Medicare and Medicaid) in the Independent Care Health Plan service area. The Medicare Benefits Consultant's primary area of focus is on achievement of the membership goals outlined in the annual operating plan. The Medicare Benefits Co
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This part time professional position is responsible for oversight of the utilization management, credentialing, and quality management functions. Provides medical expertise and acts as senior medical resource for review of complex medical and social cases. Acts as primary liaison with physicians. This position reports to the Chief Medical Officer. Assist in the development of ongoing quality impro
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Prepare, review and reconcile the encounter submissions to the various governmental agencies (State and Federal). Provide information necessary to assist the contracting department during rate negotiations and assist in the developing of standardized rates. Review Patient Protection and Affordable Care Act ("PPACA") distribution analysis received from the State of Wisconsin to identify any abnorma
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Master's Degree in Nursing. Possession of a licensure or eligibility for licensure in the State of Wisconsin as a Registered Nurse, Advance Practice Nurse Prescriber (APNP) licensure, and national NP certification in geriatrics, adult or family practice. Strong assessment and care planning skills required along with the ability to provide complex care coordination. Ability to effectively communica
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This professional position provides care management services to meet medical, behavioral health and social needs of Independent Care members while promoting and maintaining the quality of care for members. ESSENTIAL DUTIES AND RESPONSIBILITIES Conducts initial and ongoing assessment of members' (children and their caregivers) medical, behavioral and social needs. Coordinates and organizes informat
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