- Medical Mutual of Ohio (OH)
- …remote opportunity_** . **_Eastern & Central Time Zones preferred._** **Responsibilities** ** Medicare Pharmacy Coordinator I** Working under general supervision, ... (medical drug) programs as needed. . Performs other duties as assigned. ** Medicare Pharmacy Coordinator II** Working under general supervision, administers… more
- Healthfirst (NY)
- … Medicare 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 ...and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. **Compliance & Regulatory Responsibilities:** Noted… more
- The Cigna Group (Tampa, FL)
- …adherence and working to overcome those barriers by working with the clinical pharmacy team, physicians, and resources within the Medicare Health Plan. Primary ... **What will I be doing?** The Pharmacy Technician in the Stars Pharmacy ...the Part D Medication Adherence area of the Cigna Medicare Stars department. The Star rating system was developed… more
- GEHA (Lee's Summit, MO)
- …and regulatory requirements. + Work in conjunction with the Vice President and Director of Pharmacy to align Medicare Part D / EGWP lines of business to ... personalized customer experience, sustained by a nimble and efficient organization. The Medicare Part D Performance Management Specialist will report to the Director… more
- CVS Health (Blue Bell, PA)
- …+ Solid technical/analytical skills and attention to detail Preferred Qualifications + Previous Pharmacy , Medicare Part D, Medicare experience + ASA or ... team supporting CVS Health and Aetna's exciting and growing government services pharmacy business. This role will focus on analyzing financial and business impacts… more
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy . We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ ... equivalent. + Computer literate. + Previous experience in Retail pharmacy is a must. + Experience in Long Term...is a must. + Experience in Long Term Care Pharmacy . (Preferred) + Must be able to work independently… more
- Healthfirst (NY)
- …and workflows for Medicare products. + Leads the setup and monitoring of Medicare pharmacy benefits and PDE accuracy in collaboration with our Pharmacy ... Identifies opportunity for operational improvement and leads the development of new pharmacy benefit capabilities to maximize performance. + Leads the development of… more
- BlueCross BlueShield of North Carolina (NC)
- …+ Provide proactive and strategic thought leadership relating but not limited to pharmacy network, formulary, and Medicare Part D topics + Manage relationship ... **Job Description** This Consulting Actuary with a Medicare Part D focus on the Medicare...with external Pharmacy Benefits Manager as primary point of contact +… more
- Centene Corporation (Phoenix, AZ)
- …more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare Part ... Operations or Prior Authorization. Using established company guidelines, the Pharmacy Technician reviews requests made by physicians, medical groups, pharmacies and… more
- Actalent (Mcallen, TX)
- …coverage determination request decisions Skills: medical, medical terminology, health care, medicare , Pharmacy , Cpht, Pharmacy technician certification, ... Pharmacy technician certificate Top Skills Details: medical,medical terminology,health care, medicare , Pharmacy ,Cpht, Pharmacy technician certification,Prior authorization,Retail … more
- Trinity Health (Fort Wayne, IN)
- …authorizations when benefit investigation is not required; resolves aspects of specialty pharmacy insurances, including Medicare , Medicaid, PBM, and PPO and ... - located in Fort Wayne, Indiana** The Patient Assistance Pharmacy Technician in Training will participate in a work...in a work learning program to become a licensed pharmacy technician in the state of Indiana and trained… more
- Molina Healthcare (Long Beach, CA)
- …development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements… more
- CVS Health (Phoenix, AZ)
- …and affordable. **Position Summary** - Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of ... requests. - Promotes and supports quality effectiveness of healthcare and Pharmacy Services. - Evaluates, authorizes approval, and communicates decisions for … more
- BrightSpring Health Services (Las Vegas, NV)
- …is one of the pioneers in the hospice industry. Specializing in providing hospice pharmacy services since the Medicare benefit started in the 1980s, OnePoint ... prescription items, as permitted by the State Board of Pharmacy , packaging medications for dispensing and for delivery, meeting...pharmacies to begin serving the hospice industry when the Medicare hospice benefit began in the 1980s. Today OnePoint… more
- Highmark Health (Harrisburg, PA)
- …adherence strategies, Medication Therapy Management, utilization management, immunizations, specialty pharmacy , Medicare Stars, and Medicaid HEDIS to strategies ... models. The incumbent applies subject matter expertise in clinical pharmacy , pharmacy formulary, pharmacy benefit...programs for both the commercial and government business (ACA, Medicare STARS, Medicaid HEDIS, risk revenue). + Function as… more
- CVS Health (Chicago, IL)
- …+ Solid technical/analytical skills and attention to detail Preferred Qualifications + Previous Pharmacy or Medicare Part D experience + FSA designation + ... CVS Health and Aetna's exciting and growing government services pharmacy business. The primary focus is the pharmacy...role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support… more
- CareFirst (Baltimore, MD)
- …the organization's pharmacy vision and strategic plan for government programs ( Medicare and Medicaid). This role has oversight of pharmacy staff and ... quality initiatives, compliance, population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization… more
- Adecco US, Inc. (Houston, TX)
- …typically direct contact via phone, email . Understand the overall business model of Medicare Part D products, CMS guidance, the Pharmacy Benefit Manager (PBM) ... **Qualifications:** . High school diploma or GED . 3 years Medicare Part D/ Pharmacy benefit, and/or PBM experience related to eligibility, benefits and/or claims… more
- Penn Medicine (Philadelphia, PA)
- …information technology for pharmacotherapy management. + Implement and maintain clinical pharmacy programs that support meeting Medicare Core Measures. ... life's work? Pennsylvania Hospital is seeking a full time Clinical Pharmacy Specialist, Hematology/Oncology. This position is responsible for provision of… more