- Humana (Springfield, IL)
- …setting, such as managing teams, coordinating projects or initiatives, or serving as a subject matter expert . + Active Registered Nurse (RN) license or ... to make a meaningful impact on the lives of Medicaid members in Illinois? As Manager, Care Management at...social service-related field. + Experience working with Medicare and Medicaid recipients. + Knowledge of Medicaid /Medicare, and… more
- Prime Therapeutics (Springfield, IL)
- …maintenance of regulatory requirements throughout the enterprise. This position acts as the subject matter expert on applicable regulations, training, and ... customer needs with business goals. + Consults with business areas and other subject matter experts to identify compliance requirements, assess risks, and… more
- Humana (Springfield, IL)
- …standards across multiple operational areas within Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation ... Member Experience (ME) and Medicaid Module (MED) requirements, advising stakeholders on compliance. +...years of experience in NCQA Health Plan Accreditation and/or Medicaid Module. + Exceptional analytical and critical thinking skills,… more
- CVS Health (Springfield, IL)
- …standards through effective mentoring and instruction. + Serves as the training resource and subject matter expert to vendors, providers and other team ... internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate,… more
- Highmark Health (Springfield, IL)
- …team education support. Will participate on a portfolio of projects. + Serve as a subject matter expert working in concert with provider-facing teams to ... goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide… 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
- Prime Therapeutics (Springfield, IL)
- …(Medicare, Medicaid , commercial/HIM); serve as primary enterprise point of contact and subject matter expert on all client quality matters and ... plans that achieve Star Ratings and quality outcomes for Medicare, Medicaid , Individual Health Insurance Marketplace, and Commercial lines of business. This… 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
- 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
- Centene Corporation (Springfield, IL)
- …healthcare provider instructions, care options, referrals, and healthcare benefits + Serves as a Subject Matter Expert (SME) to support the care navigation ... WITH 50% TRAVEL IN ASSIGNED AREAS TO SUPPORT ILLINOIS MEDICAID MEMBERS. MILEAGE IS REIMBURSED AT THE CURRENT IRS...also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity… 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 ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- **Position Summary** The Field Reimbursement Manager (FRM) serves as the subject - matter expert on reimbursement, access, and coverage issues for our ... and coding in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in… more
- Prime Therapeutics (Springfield, IL)
- …collaboration techniques to maintain ongoing partnership between functions + Serves as subject matter expert within Compliance and develops solutions ... or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible to work… more
- Public Consulting Group (Springfield, IL)
- …and support clients. **Duties And Responsibilities** + Serves as project manager and subject matter expert , independently managing complex projects, staff, ... agency and school district clients in their efforts related to special education, Medicaid reimbursement, data management and use. While a remote role, it is… more