- 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 (East Moline, 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
- Humana (Springfield, IL)
- …requires an in-depth evaluation of variable factors. This position serves as a subject matter expert for Humana's strategies supporting physician practice ... and approaches to assignments. Position will serve as a subject matter expert (SME) for...Recognition programs across multiple lines of business (Medicare and Medicaid ). + Utilizes complex SQL, SAS, and other technical… 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
- 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 (Chicago, IL)
- …and every day. **Position Summary** The individual in this role will serve as the subject matter expert for Aetna's Medicare Advantage Special Needs Plans ... all Aetna geographies, Medicare Advantage market actuaries, and associated Medicaid actuaries. Establish best practices, ensure consistency, and provide guidance… 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
- 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)
- …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
- Humana (Springfield, IL)
- …responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring ... Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal… more