- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …business partners. **Responsibilities** + Provide oversight of operational activities of Medicare Part D /EGWP programs + Ensure compliance with CMS rules ... **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides… more
- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- US Tech Solutions (AZ)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …years directly involved in Medicare Advantage or Part D auditing activities. **Professional Certification** . Certified Compliance and Ethics ... and all compliance -related activities for the Company's Medicare Advantage ( Part C) and Prescription Drug... Advantage ( Part C) and Prescription Drug ( Part D ) health plan programs. Ensures that… more
- Humana (Columbus, OH)
- …of variable factors. The focus of this role is Medicare Pharmacy and Part D . The Senior Compliance Professional will analyze business requirements, ... **Become a part of our caring community and help us...Compliance or Health Plan Operations + Familiarity with Medicare pharmacy laws or regulations **Additional Information** **Scheduled Weekly… more
- Medical Mutual of Ohio (OH)
- …supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part ... administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical… more
- Centene Corporation (Raleigh, NC)
- …+ 5+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. + Some ... home anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory… more
- Prime Therapeutics (Columbus, OH)
- …licensure **Preferred Qualifications** + PBM/health care experience + Commercial/ Medicare Part D /Medicaid/ACA experience + Certified Compliance and ... passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Regulatory Compliants & Inquires) - Remote **Job Description** The… more
- Trinity Health (Farmington Hills, MI)
- …Vision, and Values in behaviors, practices, and decisions Performs daily activities as part of the billing and follow-up team in support of the revenue cycle ... applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… more
- Central Maine Medical Center (Lewiston, ME)
- …staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… more
- US Tech Solutions (May, OK)
- …exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided ... and Appeals Learning Advocates and management team as needed. + Must maintain compliance at all times with CMS and department standards. + Position requires schedule… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Associate Actuary, Pricing is responsible for setting pricing assumptions, submitting ... growth. Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Begins to… more
- LA Care Health Plan (Los Angeles, CA)
- …care. Ability to prioritize caseload. Knowledge of community resources. Knowledge of Medi-Cal and Medicare regulations. Ability to work as a part of a diverse ... Care Management Specialist II ( D -SNP) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition… more
- Prime Therapeutics (Columbus, OH)
- …manage multiple projects within strict timelines, under pressure. + Working knowledge of Medicare Part D , Medicaid, state healthcare product or program ... and drives every decision we make. **Job Posting Title** Compliance Principal - Remote **Job Description** The Compliance...or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Boehringer Ingelheim (Ridgefield, CT)
- …developing a comprehensive discount accrual forecasts and by providing support for Managed Care / Medicare Part D group efforts as required in order to ... Department, this individual will provide support to the Associate Director, Contract Compliance and the Director of Contract Development, as applicable, and as it… more
- Central Maine Medical Center (Bridgton, ME)
- …by reducing the patient and family's anxiety and increasing the patient's compliance d ) Develop positive relationships with other departments to foster ... among all staff and shifts. c) Effectively manages change at a departmental level d ) Identifies readiness for change and involves staff in change process e) Responds… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …of business. + Develop, refine, implement, and pull through the MTPA contracting strategy for Medicare Part D , PBMs, GPOs and Commercial + Manage all Payer ... and external groups including Commercial Payers, Medicare , Medicare Advantage plans, Part D ,...strategies. + Works with cross-functional partners (Commercial, Medical, Legal, Compliance and others) to develop a comprehensive access and… more
- Commonwealth of Pennsylvania (PA)
- …with federal and state regulations for initial licensure, re-licensure, civil rights compliance , and Medicare or Medicaid certification to assess facility ... conducting health care surveys in various facilities to determine compliance with federal and state regulations. Do not miss...duties will be performed independently, with a partner, as part of a team, or as the team coordinator… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …3. Support our Medicare Enrollment teams ( Medicare Advantage, Medex, and our Part D PDP teams) by cross training on other enrollment functions and assist ... that all documents are distributed timely to remain in compliance with the Centers for Medicare and...Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of,… more