- 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
- CVS Health (Buffalo Grove, IL)
- …meet the organizational and marketplace needs. The role will consult as a subject matter expert facilitating formulary decision-making process and continual ... possess demonstrated working knowledge of Formulary Management in Commercial and Medicaid environments; Drug File and Adjudication knowledge; and the Pharmacy and… 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
- Oracle (Springfield, IL)
- …Review, case management, and healthcare quality preferred **Responsibilities** + **Act as subject matter expert (SME):** Provide expertise for Claim ... features of Oracle Health Clinical AI Agent (CAA). This role leverages expert clinical judgment and regulatory knowledge (eg, medical necessity, level of care,… more
- Evolent (Springfield, IL)
- …aligned with value and quality outcomes** . + Support clinical reviewers as a subject matter expert and resource. + **Practice & Physician Engagement** ... delivery** . + Not under sanction or exclusion from Medicare/ Medicaid programs. To ensure a secure hiring process we...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 . + 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
- Humana (Springfield, IL)
- …aggressively growing our eCommerce acquisition channel. + Provide strategic thought-leadership as a subject matter expert within Enterprise Growth and with ... and milestones. **Use your skills to make an impact** **Required Qualifications** + Expert Digital experience (web, mobile, social and ecommerce) + 7+ years of… more
- Cardinal Health (Springfield, IL)
- …for physicians and staff regarding coding insufficiencies. + Serves as institutional subject matter expert and authoritative resource regarding federal, ... using a risk-based approach in planning and executing audit plans. + Expert -level knowledge and application of Medicare/ Medicaid documentation and coding rules… more
- Elevance Health (Chicago, IL)
- …by home visits within the scope of licensure for members with behavioral health needs. Subject matter expert in targeted clinical areas of expertise such ... and Experiences:** + **BCBA or LBA** **_STRONGLY PREFERRED_** + Commercial (not Medicaid ) experience preferred. **For candidates working in person or virtually in… more
- Huron Consulting Group (Chicago, IL)
- …the enterprise. The Coder-Inpatient provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient ... engagement across the enterprise. Join our team as the expert you are now and create your future. Huron...Official Coding Guidelines for Coding and Reporting, Centers for Medicare/ Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and… more