- 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
- CVS Health (Springfield, IL)
- …system implementation, and performing post-release checkout + Act as Project Manager/ subject matter expert on Conga Medicaid Contracting for all ... Platform Solutions - Contracts & Pricing Team to support Medicaid Contracting IT projects in Conga and to provide...+ Maintain reports and dashboards for executive leadership and Medicaid Health Plans + Support of internal and external… 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
- 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)
- …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
- 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
- Humana (Springfield, IL)
- …model, and process improvement activities **Key Accountabilities** + 20% Partnering as a subject matter expert on Humana Military strategy, tactics to ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Springfield, IL)
- …engagement, advance talent strategy, and successfully manage change + Serve as a subject matter expert , handling inquiries, developing action plans, and ... 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
- 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
- CVS Health (Springfield, IL)
- …medical appropriateness and quality of care, and care documentation. - Serves as a subject matter expert for the team regarding practice standards, ... travel up to 10% of the time **Preferred Qualifications** + Managed Medicare/ Medicaid experience preferred + Computer literacy and experience with Microsoft Excel,… more
- Prime Therapeutics (Springfield, IL)
- …and organize information into clear, accurate and effective executive reports. + Serves as subject matter expert within Compliance and develops solutions to ... 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
- 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)
- …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