- DATAMAXIS (Springfield, IL)
- …distance (3 - 5 Hours) of Springfield, IL. Functional Description: This position is a Medicaid Subject Matter Expert for the Illinois Enterprise Data ... Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations. * With the specialized… more
- Molina Healthcare (Springfield, IL)
- …to refer clients who may be eligible for other Molina products. + Viewed as a " subject matter expert " (SME) by community and influencers on the health care ... promotion and advocacy. + Strong presentation skills and broad knowledge of Illinois Medicaid is helpful. **If you are passionate about community engagement and have… more
- Public Consulting Group (Springfield, IL)
- …of Medicaid waivers. **Duties and Responsibilities** + Serves as project manager and subject matter expert within the practice including management of a ... . Summary: We are seeking a senior-level, detail-oriented and self-motivated Medicaid Waiver Evaluation Consultant to join our team. This role involves… 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
- Public Consulting Group (Springfield, IL)
- …for OCM Plan, and execution of the plan as lead advisor * Operate independently as a lead and Subject Matter Expert * Lead a team of OCM, and non SME team to ... + Business Solutions + Project Assurance An OCM consultant will provide expert support and guidance to clients ensuring projects meet objectives by increasing… more
- Humana (Springfield, IL)
- …attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an ... submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular… more
- CVS Health (Springfield, IL)
- …record auditing skills and abstraction expertise. + Serves as the training resource and subject matter expert to vendors, providers and other team members ... the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate,… 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)
- …with accreditation standards across multiple operational areas within Humana. + Serves as subject matter expert on National Committee for Quality Assurance ... Universes. + Registered Nurse or Behavioral Health professional. + Managed care, Medicaid health plan experience. + Advanced degree in a healthcare-related field.… 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)
- …senior/executive management regarding federal/state regulations in the healthcare industry. Serves as a subject matter expert by providing legal advice and ... mental health parity exams. + Identifies and reviews legal risk for buisness areas/ subject matter experts for purposes of assessing market conduct impact and… more
- WelbeHealth (Springfield, IL)
- …issues impacting implementation or operations + Serve as federal regulatory and legislative subject matter expert and effectively track, synthesize, and ... function with Congress and the Centers for Medicare and Medicaid Services (CMS) + Develop and implement meaningful engagement...receipt of key and actionable information to designated WelbeHealth subject matter experts + Create and maintain… 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"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… 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"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… 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"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… more
- Prime Therapeutics (Springfield, IL)
- …and document system enhancement scope for assigned projects + Provide leadership and serve as subject matter expert and mentor for other members of Claims IT ... to receive work direction from direct and indirect leadership + Expert communication, collaboration and negotiation skills **Preferred Qualifications** + Previous… more
- Humana (Springfield, IL)
- …and insights to achieve and improve call quality results. May also act as a subject matter expert . Decisions are typically related to resources, approach, ... Information** Ability to work schedules that include evenings and weekends, Hours subject to change based on business needs. **Virtual Pre-Screen** As part of… more
- Centene Corporation (Springfield, IL)
- …to promote the organization and its services to the community, while serving as the subject matter expert for the team. + Develop and implement strategies ... experience. Experience in working with government-sponsored population, especially Medicare, Medicaid and SCHIP. Experience in public speaking. Pay Range: $55,100.00… more
- Humana (Springfield, IL)
- …along with coordinating with both vendor and internal partners, and ERISA counsel. + Subject matter expert on all Humana sponsored retirement plans along ... 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)
- …recommending enhancements, and promoting best practices across teams. + Serve as a subject matter expert on marketing analytics capabilities, providing ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more