- 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
- Prime Therapeutics (Springfield, IL)
- …Marketplace Quality Rating System (HIM QRS). This position is also responsible to be a subject matter expert (SME) in an assigned quality area of focus, ... strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality..., Commercial/HIM); serve as primary point of contact and subject matter expert on all… 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)
- …compliance, accuracy, and operational alignment. The individual in this position serves as a subject matter expert for their assigned cohort and is expected ... Professional plays a pivotal role in driving the execution of new Medicaid implementations by owning the development of operational documentation and supporting… 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
- 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
- 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 . + 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
- 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
- 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
- Prime Therapeutics (Springfield, IL)
- …activities. **Responsibilities** + Manage a team of compliance, audit management, and/or subject matter professionals responsible for intake and triage of client ... and problem solve through the most complex compliance situations + Expert level understanding of effective compliance program principles, concepts, practices and… more
- Prime Therapeutics (Springfield, IL)
- …visible to executives and across the organization. **Responsibilities** + Collaborate as a subject matter expert (SME) with underwriters, other areas of ... in a healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years of experience in SQL and VBA +… more