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Network Health
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  • Description The IS Configuration Lead directly manages activities for... Read More
    Description The IS Configuration Lead directly manages activities for end-to-end systems configuration. This individual collaborates with the operational departments for supporting the core business functions, develops the annual lifecycle tasks with the operations and product areas, works with the Development and Architecture team to define scope within projects and utilizes new system functionality. This role serves as a key role in conducting and managing complex analytical projects affecting decisions, activities, and processes involving all areas of the organization. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Collaborate in the planning, development, and deployment of new applications, and enhancements to existing applications Build, coordinate and perform in-depth test plans, test cases and functional testing, including end-user reviews, for modified and new systems, assuring proper user acceptance testing of completed projects and other post-implementation support Maintain effective communication with software vendors to ensure that Network Health's specifications for new functionality, identified system defects and system implementation schedules are met. Provide orientation and training to end users, along with coaching, mentoring and work direction to other IT staff members for all modified and new systems Support department leader by preparing and delivering reports, recommendations, or alternatives that address existing and potential trouble areas in operating systems across the organization. Provide feedback to leader relating to individual staff performance Establish, monitor, measure and report on key quality and productivity metrics. Based on trend analysis, identify action plans to optimize performance. Monitor productivity and efficiency of operations Coach and educate the team on best practices in configuration, requirements gathering process, business/functional requirements management, and configuration implementations Monitor team standards on appropriate testing scenarios and documentation, automated system processes and SQL validations, and custom configuration scripting development with IS Identify, determine root cause and resolve operational problems and inefficiencies to ensure continued high-quality service to customers, and achieve required operational results Document processes and identify and adopt best practices to promote accuracy and efficiency Participate in planning, configuring, testing and implementing of system enhancements and assigned projects Comply with and apply standard practices in QNXT, EAM, NetworX Optum PPS and Rate Manager systems. Maintain data accuracy to ensure service level agreements are met for the systems and customers being supported. Represent company on user groups and at conferences and develops requirements for submission to vendors for system enhancements Job Requirements: Bachelor's degree or 8 years of equivalent experience required 4+ years of direct configuration experience in Cognizant products or Optum Products- or similarly structured insurance / health care platforms (eg Epic, VBA) (depending on role area), including participation on user groups and attendance at release meetings for software with shared accountability with business partners/training for translating release information to users to apply correct changes/developments in software. Minimum of 4 years' experience in a health insurance or health care related field, with alternative educational requirements acceptable as more than 6 years of experience in health insurance with 4 years of experience in business analysis, EDI or configuration of systems from Cognizant, Optum or other claims processing systems. Depending on functional team the role will be supporting, position may require: 4+ years' experience as a coder or 4+ years experience working with provider contracts or payment. SQL knowledge is preferred Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less
  • Description In support of the CMO, the Associate Medical Director is r... Read More
    Description In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel is required occasionally for the position. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday, weekend coverage required on rotational basis Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes Provide medical consultation as requested for: Medical/legal issues Member grievance procedures Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts Medical issues related to contract negotiations with health care providers Determining if services to members/enrollees meet medical criteria Promote positive relationship between NHP and medical community Serve as liaison between NHP and providers regarding matters of medical policy and medical administration Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations Participates in the ongoing recruitment of plan physicians. Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors Assist in the development of appropriate medical guidelines and parameters for claims review Assist in the training of NHP staff on matters relating to medical guidelines Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness Perform second level review of provider appeals and disputes Serve on committees as coordinated with the CMO Assist in strategic planning targeted towards plan growth initiatives Job Requirements: Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction Member in good standing of the local medical community. An active practitioner of medicine in the NHP service areas Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP's service area Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity Board certified in an ABMS medical specialty required Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less
  • Quality Care Coordinator  

    - Waukesha County
    Description The Quality Care Coordinator develops, implements and prov... Read More
    Description The Quality Care Coordinator develops, implements and provides ongoing monitoring of intervention plans and quality gap closure. The overall goal of this role is to reduce medical costs and improve quality ratings. The Quality Care Coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies. The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements. This role will have varying areas of focus depending on business need, this coordinator could be the SME for quality, condition management, clinical integration or the clinical support for the appeals and grievance process. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Provide direct outreach to members and/or providers in order to close quality gaps and maintain or exceed expected population health outcomes per HEDIS, Stars and NCQA Create written materials for members, physicians, and other customers in formats such as newsletters, brochures, self-care materials, educational handouts, letters and telephone scripts Responsible for development and coordination of member centric programs in alignment with industry and regulatory standards Evaluate utilization patterns, medical records and other metrics to monitor quality and efficiency results Provide clinical support for the appeals and grievance department and quality of care complaint process, preparing cases for medical director review when needed Identify opportunities for improvement and implements clinical interventions Prepare and/or deliver presentations for Quality Management committee, clinic or provider education, and system-wide committees as needed Coordinate, monitor, and document quality interventions and care management programs with goal of effectiveness that promotes value added care and service Collaborate closely with secondary providers (Breathe at Ease, Home Telemetry, Diabetes programs) to coordinate services for members Function as a liaison when needed for family, member and provider to communicate any current of potential issues Prepare reports as necessary Develop review and revise department policies and procedures including preventive services requirements Provide recommendations for preventive services medicine and evidence based clinical guidelines, seek approval and monitor for updates or relevant changes as assigned Research, submit, and evaluate quality improvement projects regulated by CMS as assigned Implement systems of care that facilitate close monitoring of members to promote early intervention Assist with updating and maintaining Clinical Integration (CI) manual and documentation related to CI including reports Assist with meeting directly with CI providers (frontline staff) to answer questions and come up with action plans related to CI contract, other related Clinical integration meetings that require clinical representative Manage CI provider quality improvement fund including quarterly updates, follow-up, and report out on results Assist with CI PCP attribution process and supplemental data including troubleshooting electronic medical record access. Assist with CI provider project management. Other duties as assigned. Job Requirements: Bachelors degree in related field required, Bachelors degree in Nursing preferred 4 years clinical RN experience preferred Experience in basic data analysis, quality improvement, or HEDIS medical record review, preventive care, or health plan experience preferred WI Registered Nurse (RN) licensure preferred Network Health is an Equal Opportunity Employer Qualifications Licenses Read Less
  • Associate Medical Director  

    - Waukesha County
    Description In support of the CMO, the Associate Medical Director is r... Read More
    Description In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel is required occasionally for the position. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday, weekend coverage required on rotational basis Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes Provide medical consultation as requested for: Medical/legal issues Member grievance procedures Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts Medical issues related to contract negotiations with health care providers Determining if services to members/enrollees meet medical criteria Promote positive relationship between NHP and medical community Serve as liaison between NHP and providers regarding matters of medical policy and medical administration Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations Participates in the ongoing recruitment of plan physicians. Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors Assist in the development of appropriate medical guidelines and parameters for claims review Assist in the training of NHP staff on matters relating to medical guidelines Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness Perform second level review of provider appeals and disputes Serve on committees as coordinated with the CMO Assist in strategic planning targeted towards plan growth initiatives Job Requirements: Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction Member in good standing of the local medical community. An active practitioner of medicine in the NHP service areas Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP's service area Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity Board certified in an ABMS medical specialty required Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less
  • Description Network Health's success is rooted in its mission to creat... Read More
    Description Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a driven Marketing Intern to join the team. This individual will get experience working with brand promise work, reviewing peer materials, supporting social media content/posts and working through a website audit project. As an intern with Network Health, you can expect to collaborate with the marketing team to learn about each stage of our various marketing campaigns to our members and customers. Location: Candidates must reside in the state of Wisconsin for consideration. This position will be performed out of our Menasha, WI office. Hours: 35-40 hours per week, between the hours of 8am-5pm Monday through Friday. This internship will run from May 26, 2026 through July/August (based on school schedule). Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Coordinates with marketing team members and various vendors/departments to help develop communication plans and related communications materials. Assists with various tasks required for the marketing department. Conducts formatting, peer reviews and quality checks to ensure material and content accuracy and brand consistency. Analyze data and build reports to improve communication and transparency within Marketing and other departments. Organizes and updates online databases and other mechanisms for archival/historical access and project tracking. Participates in department planning meetings, brainstorms and process improvements. Executes strategies based on annual work plans and regulations. Assists with website auditing project. Contributes ideas to improve efficiency and reduce costs and implements solutions. Appropriately applies all organizational, departmental, and regulatory principles, procedures, requirements, regulations and policies. Other duties as assigned. Job Requirements: Pursuing a Bachelor's or Associate degree in graphics, art, marketing, print, business, or related field Currently enrolled in and pursuing a bachelor's or associate degree from an accredited college or university Major in business or related field, with strength in written and verbal communication skills required. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less
  • Data Warehouse Engineer I  

    - Waukesha County
    Description The Data Warehouse Engineer I is part of a team dedicated... Read More
    Description The Data Warehouse Engineer I is part of a team dedicated to supporting Network Health's Enterprise Data Warehouse. This individual will perform development, analysis, testing, debugging, documentation, implementation, and maintenance of interfaces to support the Enterprise Data Warehouse and related applications. They will consult with other technical resources and key departmental users on solutions and best practices. They will monitor performance and effectiveness of the data warehouse and recommend changes as appropriate. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday, may be required to work later hours when system changes are being implemented or problems arise Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Perform end to end delivery of data interfaces in various stages of the Enterprise Data Warehouse in accordance with professional standards and industry best practice Perform all phases of the development lifecycle including solution design, creation of acceptance criteria, implementation, technical documentation, development and execution of test cases, performance monitoring, troubleshooting, data analysis, and profiling Consult with Developers, Engineers, DBAs, key departmental stakeholders, data governance and leadership on technical solutions and best practice Monitor and audit the Enterprise Data Warehouse for effectiveness, throughput, and responsiveness. Recommend changes as appropriate. Troubleshoot customer complaints related to system performance issues Maintain effective communication with customers from all departments for system development, implementation, and problem resolution Required to take call to assist in resolution of technical problems Other duties and responsibilities as assigned Job Requirements: Requires Associate Degree in Computer Science, Business, or related technical field; equivalent years of experience may be substituted Minimum of 1 year experience in program interfacing required Experience with T-SQL development, SSIS development, and database troubleshooting skills required Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less
  • Legal Intern - Summer 2026 (part-time)  

    - Waukesha County
    Description Network Health's success is rooted in its mission to creat... Read More
    Description Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Legal Intern to join us part-time in the Summer of 2026. As a legal intern you can expect to work closely with Network Health's legal team conducting research on laws, statutes and regulations pertaining to issues of concern or importance to the organization. You can expect to gain experience in various types of law including, but not limited to, administrative law, employment law, health law and compliance/privacy law. Possible projects the Legal Intern may work on include: Administrative Law : Collaborating with our Appeals and Grievances team to help identify trends in Medicare Administrative Law Judge hearing outcomes. Opportunities to attend hearings will also be available. Employment Law : Partnering with Human Resources to offer trainings and reminders on best practices regarding the FMLA, ADA, etc. Professional Conduct : Developing resources and conducting trainings on the Attorney-Client Privilege and how business leaders can help protect the privilege when communicating with in-house counsel. Contracts: Opportunities to review vendor contracts and polish issue spotting skills unique to different types of contracts under the supervision of in-house attorneys. This internship is part-time (24 hours per week) starting May 26, 2026 through July/August (based on school schedule). Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both with our hybrid workplace model. Travel to the corporate office in Menasha will be required occasionally for the internship, including on first day. Hours: 0.6 FTE, 24 hours per week, between the hours of 8am-5pm Monday through Friday Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities: Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies Employment Law- partner with Human Resources to offer trainings and reminders on best practices regarding the FMLA, ADA, etc. Contracts- assist in the review of applicable contracts, summarizing requirements as directed HIPAA/Privacy - learn about the risks associated with improper disclosure and how to protect against them Administrative Law - learn how Network Health monitors forthcoming regulatory guidance and implements it within the organization Maintain all documents and information as strictly confidential, maximizing Company's ability to claim legal and other applicable privileges Maintain working knowledge of updates and trends on laws, and applicable legal requirements pertaining to Company business Perform all job duties and in accordance with Network Health's corporate values of Innovation, Service Excellence, Integrity, Collaboration, and Accountability, with a focus on best practices and continuous improvement and accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments Other duties and responsibilities as assigned Internship Requirements: Candidates must be currently enrolled in an accredited law school program. Strong oral and written communication skills with the ability to listen mindfully, identify gaps and ask appropriate questions Strict adherence to client confidentiality Solid grasp of the concept of legal compliance Strong research and analytical skills, sound judgment, and innovative thinking Accurate and detail-oriented Uncompromising integrity and high ethical standards personally and professionally Rising 2L and 3L candidates will be considered Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Read Less

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