- Cambia Health Solutions, Inc (Portland, OR)
- …activities.Directs activities necessary to assure compliant operation of Medicare Advantage and Medicare Part D contracts as well as MediGap products ... To develop and oversee compliance with Medicare Part C and Part D ...compliance related activities, legislative and regulatory activities, health insurance operations or legal research or equivalent combination of education… more
- ConsultNet (North Kingstown, RI)
- …a complex, inbound Customer Care center. Customer Care Manager, Rx will focus on supporting our Medicare Part D and PBM business by providing a complex level ... The Customer Care Manager supervises daily operations and team members while ensuring efficiency, cost-effectiveness,...of service to Medicare Part D and Commercial...of service to Medicare Part D and Commercial PBM members and… more
- Centene Corporation (Phoenix, AZ)
- …Pharmacy Service Center, Medicare Part D / Part B, Appeals, Medicare Part D Operations and State Health Programs Pharmacy Operations or ... with Clinical Pharmacists or Regional Medical Director on related issues. + Prior Authorization Medicare Part D and Part B + Tracks and triage coverage… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides ... oversight and management of Medicare Part D /EGWP program. **Job... + Support vendor relationships (eg Plan Sponsor), daily operations , and implementation of EGWP pharmacy programs + Understand… more
- Healthfirst (NY)
- … Clinical Programming and Operations , Provider Performance, Medical and Pharmacy Part D cost savings, and Medicare Star Ratings/member experience. ... Programming and Operations + Provider performance + Medical and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. **Compliance &… 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
- Central Maine Medical Center (Lewiston, ME)
- …the Nursing Director, the Nurse Leader is responsible for the day-to-day operations of assigned responsibilities and is accountable for assuring the consistent use ... 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… more
- UCLA Health (Los Angeles, CA)
- …Healthcare, or a related field required. + Five or more years of experience in a Medicare Advantage and Part D Managed Care compliance role is required. + ... processes that maintain essential elements of our compliance efforts within the Medicare Advantage program. In this role, you'll oversee policy and procedure… more
- The Cigna Group (Nashville, TN)
- … Operations . + Responsible for analysis and interpretation of moderate to complex Medicare Part C and D financial information. Utilizes independent ... (BFO), supporting the Midwest and MidAmerica markets of our Medicare Advantage business. We are seeking a creative and...able to lead and delegate responsibilities as needed + Medicare Advantage experience and general knowledge of the healthcare… more
- Catholic Health Initiatives (Bismarck, ND)
- …basis as required for Medicare Part B and Medicare Part D . + Actively participates in retail pharmacy operations . + Maintaining confidentiality ... throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing… more
- InnovaCare (San Juan, PR)
- …members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to ... Job Description BUSINESS UNIT: MMM Holdings, LLC DEPARTMENT: Service Operations Department - Call Center POSITION: Customer Service Representative...their covered Part D drugs. Orlando Family Physicians, a… more
- Prime Therapeutics (Columbus, OH)
- …information, responding to questions and resolving complex problems and issues. + If supporting Medicare Part D , will be responsible for implementing CMS ... understanding of operating infrastructure of Strategic Business Unit(s) (SBUs) operations to be able to proactively analyze and identify...Big 4 public accounting experience. + For roles supporting Medicare Part D : Medicare… more
- The Cigna Group (Nashville, TN)
- …Patient Assistance Programs and/or experience as a supervisor/manager a plus. + Knowledgeable with Medicare , Medicare Part D benefits, and Stars Program. ... **Job Summary:** The Operations Supervisor is responsible for the daily activities...applications, tracking applications and refills for patient care. The Operations Supervisor will be responsible for a wide variety… more
- The Mount Sinai Health System (New York, NY)
- …methodologies. c. Collects, organizes, integrates, analyzes and interprets data. d . Leverages advanced statistical analysis methods to create insightful ... to focus their efforts to maximize contract performance and clinical effectiveness. d . Quality and Documentation Helps to link payer quality and documentation… more
- Lumeris (IL)
- …you for your interest in Lumeris. **Position:** Director Physician Partner Operations **Position Summary:** Oversees delivery management for Lumeris partners to ... outcomes for health system and provider accounts. Oversees and owns operations for health system customers. **Job Description:** **Primary Responsibilities** +… more
- Takeda Pharmaceuticals (Boston, MA)
- … Part B regional carriers, Medicare Part C managed care, Medicare Part D drug plans, all third party commercial payer, including health ... and in-depth knowledge in obtaining reimbursement with third party commercial payers, Medicare Parts D and B, Medicaid, VA/DOD, integrated payer healthcare… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer ... Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare...discount program, impose inflation rebates for Part B and Part D … more
- CVS Health (Northbrook, IL)
- …infrastructure to establish a new department supporting invoicing and accounts receivable management for Medicare Part D members utilizing the Medicare ... Reinstatements, Balancing/Reconciliations/Out-of-Balance Research, Disputes, and Cash Application. M3P is a Medicare Part D requirement effective January 1,… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer ... Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Information Technology...discount program, impose inflation rebates for Part B and Part D … more
- AdventHealth (Tavares, FL)
- …Clinical Ladder Program **Our promise to you:** **Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in ... is a registered professional nurse who supports the Nurse Manager in overall operations of their assigned unit.** **Is able to demonstrate critical thinking skills,… more
