- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and… more
- Eisai, Inc (Boston, MA)
- …the US healthcare system across major payer segments ( Medicare , Medicaid, Federal , and Commercial) Strong understanding of medical and pharmacy benefits, ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...Customers: Market Access, Marketing Teams, Government Relations, Legal and Compliance Key External Customers: Health Care Professionals and stakeholders… more
- Healthfirst (NY)
- …performance + Medical and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. ** Compliance & Regulatory Responsibilities:** Noted above. ... specific Medicare performance areas such as Risk Score Accuracy, Medicare Clinical Programming and Operations, Provider Performance, Medical and Pharmacy… more
- Humana (Columbus, OH)
- …clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Humana (Columbus, OH)
- …internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or ... authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which...group practice management + Utilization management experience in a medical management review organization, such as Medicare … more
- USAA (San Antonio, TX)
- …Medicare Supplement and Medicare product management. + Working experience with Medicare State and Federal Regulations + Working knowledge Medicare ... currently seeking a talented **Business Process Owner I** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee will… more
- CVS Health (Nashville, TN)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations. The Medicare … more
- Providence (OR)
- …to optimize performance + Analyzing and interpreting regulatory guidance to ensure compliance with Medicare Advantage bid requirements + Collaborating with ... empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing and maintaining actuarial… more
- CVS Health (Harrisburg, PA)
- …implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of ... large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare PDP, MAPD and employer… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Group Medicare Proposal Development/Contract Review Professional 2 reviews solicitations and prepares routine ... simple requests for proposals (RFPs)/request for renewals (RFRs). The Group Medicare Proposal Development/Contract Review Professional 2 is primarily responsible for… more
- Kelly Services (Port Neches, TX)
- ** Medicare Agent** **Location:** Beaumont, TX + Remote **Employment Type:** Full-Time / Part-Time **Salary:** Depending on experience + Commission **Key ... Responsibilities:** + **Client Consultations:** Understand clients' needs and explain Medicare options + **Plan Recommendations:** Compare and recommend Medicare … more
- Somatus (Mclean, VA)
- … for risk score accuracy. + Responsible for the program to meet full compliance with state, federal and partner requirements. + Drives industry best practices ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… more
- CVS Health (Salt Lake City, UT)
- …for ensuring broker adherence to all CMS and Aetna guidelines by monitoring compliance with state, federal , and health plan regulatory requirements. - Maintains ... care more personal, convenient and affordable. **Position Summary** Aetna is looking for a Medicare Sales Broker Manager to join the Utah sales team who will drive… more
- CVS Health (Tallahassee, FL)
- …help prospects navigate through our website as well as answer questions regarding Medicare eligibility and benefits. Guide prospects on how to self enroll. Complete ... navigation. Valid license to sell healthcare plans. Minimum of 2 years selling Medicare plans in a telesales environment. Ability to pass AHIP exam on an… more
- CVS Health (Blue Bell, PA)
- …Part D Business, with a focus on pricing, modelling, and bid development and compliance activities for MAPD, SNP and PDP products. The colleague will: + Work with ... and attention to detail Preferred Qualifications + Previous Pharmacy, Medicare Part D, Medicare experience + ASA...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- UCLA Health (Los Angeles, CA)
- …this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running processes/jobs ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- MetroLink (Los Angeles, CA)
- …industry, and other organizations on purchasing related procedures, policies, and contract compliance . + Enforce county, state, and federal regulations, laws, ... Senior Contract & Compliance Administrator Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/4642379) Apply Senior Contract...by SCRRA, which exceeds $50,000, be added to your Federal , State, and Medicare taxable earnings for… more
- Robert Half Management Resources (Nashville, TN)
- …and is primarily involved in ensuring that all operational functions are in compliance with federal , state, and local regulatory requirements within the health ... health insurance industry is looking for a Director of Compliance to join their team. This role offers a...client is interested in a candidate with experience in Medicare and Medicaid, but the primary focus is commercial… more
- Nuvance Health (Danbury, CT)
- …identified by Compliance Management; Reviews documentation and coding to ensure compliance with all Federal and State guidelines. Ensure correct DRG and ... Federal and State regulatory, and reimbursement guidelines maintaining compliance . 4. Assists with development, updating, maintenance, and disseminating training… more
