- Highmark Health (Springfield, IL)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Humana (Springfield, IL)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Springfield, IL)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- CVS Health (Springfield, IL)
- …problem-solving abilities **Preferred Qualifications** Clinical Coding Experience - Content Manager Claim Processing Medicaid Working with SQL Application ... and every day. Remote: can work anywhere in the US **Position Summary** Medicaid Claim Editing Content Management team. Must oversee ongoing content delivery and… more
- Prime Therapeutics (Springfield, IL)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Humana (Springfield, IL)
- …health outcomes for our dual members - members that qualify for both Medicare and Medicaid . The Lead Product Manager sits in the center of strategy, design, ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Prime Therapeutics (Springfield, IL)
- …our passion and drives every decision we make. **Job Posting Title** Client Quality Manager Stars and Quality - Remote **Job Description** The Senior Client Quality ... Manager ensures the successful planning, implementation and execution of...provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating… more
- Prime Therapeutics (Springfield, IL)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- Humana (Springfield, IL)
- …of Case Management team on cases with support needs. Ensures regulatory compliance by aligning care management policies, procedures, and processes to maintain ... initiatives to maintain focus on performance goals and standards, quality and compliance measures with development of action plans to improve results. + Ensures… more
- Humana (Springfield, IL)
- …we expand our cloud capabilities, we are looking for a Principal Product Manager to lead our multi-CSP strategy, drive cross-domain collaboration, and optimize our ... customer onboarding experience. As a Principal Cloud Platform Product Manager , you will own the vision, strategy, and execution for our multi-cloud platform-focusing… more
- Prime Therapeutics (Springfield, IL)
- …management in the areas of problem identification and resolution, process improvements, compliance with Centers for Medicare & Medicaid Services (CMS) ... passion and drives every decision we make. **Job Posting Title** Vendor Program Manager Senior **Job Description** The Vendor Program Manager is responsible for… more
- Gentiva (Springfield, IL)
- …in people's lives every day. **Overview** We're looking for a **Patient Care Manager ** to join our team.You will report directly to the Executive Director, ... Administrator, or Senior Patient Care Manager . You will be responsible for maintaining a high...and ensuring adherence to company policies and procedures and compliance with local, state, and federal regulations and regulatory… more
- Datavant (Springfield, IL)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- Humana (Springfield, IL)
- …licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager , Medicare Sales motivates and drives a team of Medicare Sales Field ... and train a team of sales individuals. The Senior Manager , Medicare Sales must have a solid understanding of...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Lundbeck (Springfield, IL)
- …anticipate and effectively address payer access issues (IDNs, Medicare, Medicaid , Commercial) using Lundbeck resources. **Pharmaceutical Environment/ Compliance ** ... Multi-Specialty Account Manager - Springfield, IL Requisition ID: 6496 Location:...the primary care and neurology settings. As an Account Manager , you lead the promotion of our psychiatry portfolio,… more
- Lundbeck (Springfield, IL)
- …anticipate and effectively address payer access issues (IDNs, Medicare, Medicaid , Commercial) using Lundbeck resources. **Pharmaceutical Environment/ Compliance ** ... Psychiatry Account Manager - Springfield, IL Requisition ID: 5703 Location:...on our journey of growth! As a Psychiatry Account Manager , you lead the promotion of our psychiatry portfolio,… more
- CVS Health (Springfield, IL)
- …can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With ... clinical tools and information/data. + Utilizes case management processes in compliance with regulatory and company policies and procedures. + Facilitates… more
- Centene Corporation (Springfield, IL)
- …workplace flexibility. **2 POSITIONS AVAILABLE** **THESE POSITIONS ARE SUPPORTING ILLINOIS MEDICAID YOUTHCARE/FOSTER CARE PROGRAM. THE WORK SCHEDULE IS MONDAY - ... and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides… more
- CVS Health (Springfield, IL)
- …into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor ... in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and… more
- Humana (Springfield, IL)
- …plans. Key Accountabilities We are seeking a highly skilled Lead Digital Program Manager to oversee the development and execution of a new eCommerce business. This ... independently, ensuring alignment with strategic objectives. The Lead Digital Program Manager will play a key role in establishing the structure, frameworks,… more