- Daiichi Sankyo, Inc. (Bernards, NJ)
- …but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and ... Lead drafting and negotiating contracts for commercial, Medicaid and Medicare coverage, as well as other government contracts, trade/distribution agreements,… more
- Daiichi Sankyo, Inc. (Boston, MA)
- …the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes ... in a compliant/ethical manner. Handle PHI appropriately by ensuring compliance with HIPPA regulations, laws, and internal company guidelines.Control business… more
- Lundbeck (Philadelphia, PA)
- …to promoted portfolio using Lundbeck resources. Utilize deep understanding of Medicare payer landscape in addition to other payer channels including Medicaid ... and Commercial. Pharmaceutical Environment/ Compliance - Ability to apply knowledge of pharmaceutical and regulatory environment, including accountability and… more
- Lundbeck (MA)
- …anticipate and effectively address payer access issues (IDNs, Medicare , Medicaid, Commercial) using Lundbeck resources. Pharmaceutical Environment/ Compliance ... - Ability to apply knowledge of pharmaceutical and regulatory environment, including accountability and adherence to Lundbeck policies and procedures and FDA regulations regarding the promotion of pharmaceutical and medical products.REQUIRED EDUCATION,… more
- Daiichi Sankyo, Inc. (Seattle, WA)
- …the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes ... in a compliant/ethical manner. Handles PHI appropriately by ensuring compliance with HIPPA regulations, laws and internal company guidelines.Control business… more
- Merck & Co. (North Wales, PA)
- …management accountsLTCNational and regional health plans and PBMs (Commercial, Managed Medicaid, Medicare Part D)The US Market Access Contracting Team acts as a ... business decisions.Ensure contract strategies are implemented effectively and in compliance with required obligations (eg, legal, financial).Responsible for … more
- Eisai, Inc (Boston, MA)
- …Customers: Market Access, Marketing Teams, Government Relations, Legal and Compliance Key External Customers: Health Care Professionals and stakeholders responsible ... understanding of the US healthcare system across major payer segments ( Medicare , Medicaid, Federal, and Commercial) Strong understanding of medical and pharmacy… more
- Merck & Co. (North Wales, PA)
- …as part of the Inflation Reduction Act, state Prescription Drug Affordability Boards, Medicare , Medicaid, and 340b, while planning for the loss of exclusivity of key ... Development (BD), Global Market Access (GMAX), Global Marketing, Legal, Compliance , State Government Affairs, and strategic alliance partners. The successful… more
- Molina Healthcare (Bowling Green, KY)
- …+ Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards. **Operational Excellence** + Oversee ... leaders and staff are working on retention and expansion initiatives. + Ensure compliance with Medicare guidelines and regulations. + Drives and maintains… more
- Intermountain Health (Broomfield, CO)
- …all Medicare support departments. Gains a thorough understanding of the Medicare Compliance Regulations. Establishes self as a subject matter expert. ... responsibility to achieve the budgeted membership sales goals for SelectHealth Medicare lines of business. Establishes strong relationships with brokers, agents and… more
- UCLA Health (Los Angeles, CA)
- Description As the Assistant Director of Medicare Advantage Audit and Fraud Compliance , you'll play a crucial role in safeguarding our health plan resources and ... compliance , Fraud, Waste, and Abuse (FWA) within our Medicare Advantage and Prescription Drug programs. Leading a team...field, required + Eight or more years of relevant compliance experience in a Medicare Managed Care… more
- The Cigna Group (Bloomfield, CT)
- …opportunities, and implementing initiatives to drive improved rating performance + Medicare Compliance experience preferred + Project Planning experience ... to deliverables related to Corporate Integrity Agreement as well as key compliance related deliverables. Identify gaps in operational infrastructure to ensure the… more
- The Cigna Group (Atlanta, GA)
- …skills a must + Direct response and digital media experience + Medicare or healthcare compliance experience + Leadership skills imperative **Qualifications ... with other channels, meet brand standards and can positively impact Cigna's Medicare PDP growth goals. **Responsibilities** + Partner to provide the strategic… 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
- Dana-Farber Cancer Institute (Brookline, MA)
- …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, ... position is full remote with occasional time onsite.** The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical...updates to the coverage analysis to ensure on-going regulatory compliance + Serves as the primary point of contact… more
- Dartmouth Health (Lebanon, NH)
- … regulations related to the First-Tier, Downstream and Related Entity (“FDR”) Medicare Compliance Program Guidance in collaboration with DH Corporate ... with Medicare Advantage directed First-Tier Downstream Related Entity (FDR) compliance program. Administration activities will include, but are not limited to,… more
- Humana (Annapolis, MD)
- …risk, compliance , regulatory or related experience). + Regulatory or Medicare /Medicaid compliance experience. + Auditing experience working with auditing ... first** Humana Healthy Horizons in Virginia is seeking a Compliance Professional 2 who will lead incoming regulatory audits,...agencies, such as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs. + Supports… more
- Medical Mutual of Ohio (OH)
- …under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare ... general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C… more
- Healthfirst (NY)
- …Provider performance + Medical and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. ** Compliance & Regulatory Responsibilities:** Noted ... on all aspects related to one or more specific Medicare performance areas such as Risk Score Accuracy, ...Medicare performance areas such as Risk Score Accuracy, Medicare Clinical Programming and Operations, Provider Performance, Medical and… more
- Prime Healthcare (Inglewood, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both… more
