- DATAMAXIS (Springfield, IL)
- …Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations. + With the specialized ... knowledge of the Medicaid and Children's Health Insurance Programs, lead and guide...and third-party liability. + Proactively identify and understand state Medicaid agency data needs and determines the recommended solution… more
- Prime Therapeutics (Springfield, IL)
- …Description** The Functional Business Consultant serves as a business system or business process subject matter expert with a high level of understanding of ... Represents assigned business system or business process as a subject matter expert in business...process change and/or project management in supporting Compliance with Medicaid requirements. + Provide direct, or indirect leadership to… more
- CVS Health (Springfield, IL)
- …must collaborate cross functionally to achieve plan goals including:** 1. Serving as a subject matter expert and provide oversight of the design, ... with known or potential health related resource needs. 10. Collaborating with and provide subject matter expertise to the product team to arrive at new and… more
- Humana (Springfield, IL)
- …implementation activities. The Senior Implementation Business Project Manager will serve as a subject matter expert and provide oversight to the development ... a managed care healthcare system or health plan. + Experience working in Medicaid and/or Medicare. **Preferred Qualifications** + 3+ years of experience in a… more
- Option Care Health (Springfield, IL)
- …decision-making within ethical boundaries and optimizing business performance. Serves as a subject matter expert in health care compliance including, ... regulatory requirements, and our compliance program. The Vice President provides expert guidance on strategic initiatives, day-to-day operations, and leads the… more
- J&J Family of Companies (Chicago, IL)
- …departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert regarding education and insights on access and ... representatives and key account managers and serve as reimbursement expert for the local team . Act with a...solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care, Commercial). . Execute business in accordance… more
- Prime Therapeutics (Springfield, IL)
- …is Centers for Medicare & Medicaid Services (CMS) compliant + Act as a Subject Matter Expert (SME) for MTM programs; answer questions and provide ... The Senior Medication Therapy Management (MTM) Service Specialist will act as a Subject Matter Expert for MTM programs. The position is responsible for… more
- Evolent (Springfield, IL)
- …do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert . + Conduct peer-to-peer discussions with treating ... both part-time and full-time options available.** **What You'll Do:** + Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert … more
- Humana (Springfield, IL)
- …standards across multiple operational areas within Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation ... professional. + Advanced degree in a healthcare-related field. + Managed care, Medicaid health plan experience. **Additional Information** + **Workstyle:** This is a… more
- Humana (Springfield, IL)
- …standards across multiple operational areas within Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation UM ... Registered Nurse or Behavioral Health Licensed Professional. + Managed care, Medicaid health plan experience **Additional information** + **Workstyle:** Remote +… more
- Prime Therapeutics (Springfield, IL)
- …to management on major matters pertaining to policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, ... Medicare, Medicaid , Corporate Compliance, Compliance Assessment or Services etc.) +...enterprise training programs through a variety of channels + Expert level understanding of effective compliance program principles, concepts,… more
- Molina Healthcare (Joliet, IL)
- …CSST resolution support, and National Contract Management support services. * Serves as a subject matter expert for other departments. * Conducts regular ... position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage complex providers, including… more
- Humana (Springfield, IL)
- …and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert competent to work at very high levels ... Cloud Certified Professional Cloud Network Engineer, Microsoft Azure Solutions Architect Expert + Microsoft Azure Network Engineer Associate + Network engineering… more
- Evolent (Springfield, IL)
- …when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert . + Discusses determinations (peer to peer phone ... state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"...the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our… more
- Evolent (Springfield, IL)
- …when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert . + Provides clinical rationale for standard and ... state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"...the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our… more
- CVS Health (Springfield, IL)
- …and analysis of reports as part of negotiation and reimbursement modeling activities. * Subject Matter Expert support for questions related to network ... . 7+ years of provider contracting experience * Knowledge of Medicare and Medicaid programs. * Ability to travel nationally as needed (up to 25% travel)… more
- Humana (Springfield, IL)
- …cybersecurity concepts to diverse audiences. This position requires working with technical subject matter experts, business stakeholders, and senior leaders to ... development life cycle models and experience applying to program delivery . Expert knowledge of traditional project management principles and Agile (Scrum, Kanban,… more
- Humana (Springfield, IL)
- …linkages to related areas. In this role, you will serve as a regulatory compliance subject matter expert with the 2nd line of defense compliance function. ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Prime Therapeutics (Springfield, IL)
- …Assurance and UAT resources to review related test cases and/or scenarios + Serve as subject matter expert and mentor for more junior members of Specialty ... Benefit Management (PBM) or healthcare experience with understanding of Medicare, Medicaid , the Exchanges along with regulatory compliance requirements (HIPAA and/or… more
- Prime Therapeutics (Springfield, IL)
- …document SPS client contractual requirements applicable to Prime suppliers and subcontractors + Serve as subject matter expert for VLM support of SPS line of ... or GED is required + 2 years of work experience in healthcare, PBM, state Medicaid plans, specialty pharmacy, or health care consulting + Must be eligible to work in… more