- Centene Corporation (Springfield, IL)
- …licensed in Illinois, and have experience in various mental health settings and utilization management / review . **Position Purpose:** Performs a clinical ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Evolent Health (Springfield, IL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Centene Corporation (Springfield, IL)
- …Medical License preferred. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... + Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- Prime Therapeutics (Springfield, IL)
- …Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service ... **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases...guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization… more
- Marriott (Springfield, IL)
- …be employed by a franchisee and not by Marriott International, Inc. JOB SUMMARY: The remote role of the Director Revenue Management is to provide direction to ... **Job Number** 24136294 **Job Category** Revenue Management **Location** Laguna Cliffs Marriott Resort & Spa,...full service premium branded hotel. This position is a remote position encompassing 25% in the office or one… more
- Prime Therapeutics (Springfield, IL)
- …support to one or more of Prime's functional areas: Clinical Program Management , Utilization Management (UM), Formulary, GuidedHealth, Pharmaceutical Trade ... internal program reporting, which may include UM Savings, Compliance, Utilization data, Retrospective Drug Utilization Review... skills + Knowledge or experience with formulary or utilization management + Proficient in MS Access… more
- ICF (Springfield, IL)
- …weekly client engagements, facilitating client interviews, and writing a plan for management review . You will work with leadership, and engineering disciplines ... ICF is seeking a **Broadband Project Manager** with **Federal Grants Management ** experience who will lead our initiatives under the Infrastructure Investment… more
- Prime Therapeutics (Springfield, IL)
- …every decision we make. **Job Posting Title** Health Data Analyst - Remote **Job Description** The Health Data Analyst provides information, analyses, and ... responsible for Centers for Medicaid/Medicare Services reporting and analysis, including the management of directories and bid support + Other duties as assigned… more
- Highmark Health (Springfield, IL)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Prime Therapeutics (Springfield, IL)
- …**Job Posting Title** Contract Manager Vendor Performance - LA Medicaid - Remote **Job Description Summary** Responsible for the implementation and support of all ... all areas of the Prime Therapeutics organization to coordinate network management and network administration responsibilities and facilitates resolution of contract… more
- Prime Therapeutics (Springfield, IL)
- …and written communication skills. + Knowledge of legislative/oversight bodies (eg, URAC- Utilization Review Accreditation Commission, CMS-Centers for Medicare & ... **Job Posting Title** Director, Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary** Responsible for support and development of… more
- Prime Therapeutics (Springfield, IL)
- …the primary clinical relationship manager. This role's responsibilities may include the management of drug formulary, Utilization Management (UM) programs, ... every decision we make. **Job Posting Title** Clinical Program Mgmt Director - Remote Must Reside in Alabama **Job Description** The Clinical Program Management … more
- Prime Therapeutics (Springfield, IL)
- …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... drives every decision we make. **Job Posting Title** Clinical Program Manager Remote **Job Description** **This Clinical Program Manager opening is presenting a… more
- Prime Therapeutics (Springfield, IL)
- …drives every decision we make. **Job Posting Title** Marketing Manager - Remote **Job Description** The Marketing Manager is responsible for driving the development ... stakeholders to understand Prime's business objectives, product offerings, client utilization /adoption and history, and intended market positioning + Translate… more
- Prime Therapeutics (Springfield, IL)
- …every decision we make. **Job Posting Title** Sr. Director Actuarial Services - Remote **Job Description** The Senior Director of Actuarial Services leads a team of ... complex actuarial modeling + Collaborates with underwriters, client engagement, and senior management on RFP process and other pricing initiatives related to all… more
- Sharecare, Inc. (Springfield, IL)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
- Humana (Springfield, IL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Springfield, IL)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- CVS Health (Springfield, IL)
- …basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and ... effective use of health care resources. **This is a remote based (work at home) based anywhere in the...policy and appeals to the appeal nurses and territory Utilization Management Staff * Participate in ongoing… more
- Verint Systems, Inc. (Springfield, IL)
- …enrollment processes, including obtaining and analyzing benchmark data and utilization data, identifying trends, preparing recommendations with impact assessments ... covering the four pillars. + Responsible for all aspects of leave management , 401(k), tuition reimbursement, paid time off, annual holiday schedules and worker's… more