Top Tech Jobs & Startup Jobs in Chicago, IL

Manage Quality Assessment and Performance Improvement programs across hospice agencies, ensuring compliance and enhancing patient care while conducting site surveys and supporting staff education.

Provide clinical oversight for utilization management and care transitions, perform daily UM reviews and peer-to-peer discussions, liaise with network and community providers, support care coordination and analytics needs, participate in medical advisory activities, and provide intermittent weekend/evening coverage.

Lead state and federal Medicaid reporting projects as the analytics SME and liaison between state business stakeholders and Optum technical teams. Drive data warehouse/reporting solutions, manage cross-functional teams, ensure federal compliance, present executive insights, and guide analytics product direction and delivery.

Provide clinical oversight for inpatient care management, perform medical necessity and length-of-stay reviews, collaborate with providers and operational partners, apply evidence-based guidelines, support quality initiatives, and participate in rotational call and holiday coverage.

Develop and own long-range staffing forecasts using statistical models, partner with Operations/Finance/vendors to align budgets and FTEs, present findings to leadership, analyze drivers and contact rates, manage cross-functional dependencies, and recommend fiscally responsible staffing solutions.

Senior technology leader responsible for defining and executing OptumRx Pharmacys multi-year technology and AI strategy, modernizing platforms (cloud, DevOps, automation), ensuring security and reliability, managing large global teams and budgets, and driving innovation, governance, and talent development to support business growth.

Provide physician oversight for clinical coverage and utilization management in cardiology, conduct pre-service benefit and medical necessity reviews, document findings, engage in peer-to-peer discussions, collaborate with providers and internal teams, and participate in rounds and occasional call/holiday coverage to ensure cost-effective, quality care.

Provide physician oversight for medical claims and coverage determinations in plastic surgery, collaborate with providers and internal teams, document reviews, and participate in utilization management and quality improvement.

Provide physician oversight for clinical coverage and post-service medical necessity determinations for urology cases, document findings, engage in peer-to-peer discussions, collaborate with providers and internal teams, and support quality, cost-effectiveness, and policy interpretation in utilization management.

Provide clinical oversight for utilization management of pain procedures, conduct and document coverage reviews, render determinations, ensure regulatory compliance (CMS/NCQA/URAC), coordinate with clinical staff and treating providers, participate in training, quality improvement, and rotational call coverage.