- Prime Therapeutics (Springfield, IL)
- …our passion and drives every decision we make. **Job Posting Title** Sr . Compliance Analyst - Remote **Job Description** The Senior Compliance Analyst ... Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management Professional (PMP)… more
- Public Consulting Group (Springfield, IL)
- …more, visit www.publicconsultinggroup.com . Summary: We are seeking a senior -level, detail-oriented and self-motivated Medicaid Waiver Evaluation Consultant ... background in data science, healthcare analytics, and a deep understanding of Medicaid waivers. **Duties and Responsibilities** + Serves as project manager and… more
- CVS Health (Chicago, IL)
- …utilization/performance, network growth, and efficiency targets. Manages and oversees compliance within our network responsibilities as provided within the state ... Medicaid contractual requirements. This position holds a variety of...others to support staff. + Process Improvement: Work with Sr . Managers and Director to develop and implement strategies… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Senior Data and Reporting Professional generates ad hoc reports and regular datasets ... and database or data warehouse queries and scripts. The Senior Data and Reporting Professional work assignments...off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer… more
- Humana (Springfield, IL)
- …claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will ... development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root… more
- The Cigna Group (Chicago, IL)
- The Director of Medicaid and Marketplace Strategy leads a team of Client Strategists to support health plan clients in achieving quality and regulatory goals, ... of a roadmap that enables Express Scripts to differentiate itself, while ensuring compliance with all requirements. Ability to assess the market and identify key… more
- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Senior Risk Management Professional identifies and analyzes potential sources of loss to ... minimize risk. The Senior Risk Management Professional work assignments involve...implements controls and cost-effective approaches to minimize risk of Medicaid operations within Humana's Payment Integrity Unit. Assesses and… more
- Humana (Springfield, IL)
- …community and help us put health first** The Value Based Market Support Senior Professional is responsible for providing comprehensive market support across ... Responsible for end to end market support for assigned Medicaid markets to ensure markets achieve their VBP contract...+ Consult with market on VBP strategy to ensure compliance with contractual requirements and market goals + Provide… more
- Molina Healthcare (Chicago, IL)
- …and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality ... more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-, program-, and… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Senior Data & Reporting Professional tests the overall network in each county of ... to ensure the network is strong enough to support serving customers. The Senior Network Adequacy Professional work assignments involve moderately complex to… more