• Lundbeck (Little Rock, AR)
    …anticipate and effectively address payer access issues (IDNs, Medicare , Medicaid, Commercial) using Lundbeck resources. Pharmaceutical Environment/ Compliance ... transform lives. Join us on our journey of growth!As a Psychiatry Account Manager , you lead the promotion of our psychiatry portfolio, executing sales and marketing… more
    HireLifeScience (02/15/25)
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  • Lundbeck (Flint, MI)
    …and transform lives. Join us on our journey of growth!As a Neuroscience Account Manager , this is an incredible opportunity to join the growing promotion of our CNS ... to promoted portfolio using Lundbeck resources. Utilize deep understanding of Medicare payer landscape in addition to other payer channels including Medicaid… more
    HireLifeScience (02/01/25)
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  • Lundbeck (Seattle, WA)
    …lead the way in creating positive customer experiences!As a BioPharmaceuticals Account Manager , you lead the promotion of our infusion product, driving demand ... internal and external partners and effectively addresses payer access issues ( Medicare , Medicaid, Commercial) using Lundbeck resources. Local Market & Therapeutic… more
    HireLifeScience (01/31/25)
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  • Merck & Co. (AR)
    …company's divisions and functional areas; ensureintegration with the Key Account Manager , Nurse Educator, Field Reimbursement Associate, Medicare Account ... consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco Fair Chance Ordinance Los Angeles Residents… more
    HireLifeScience (02/08/25)
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  • Merck & Co. (Memphis, TN)
    …divisions and functional areas; ensure - integration with the Key Account Manager , Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and ... consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco Fair Chance Ordinance Los Angeles Residents… more
    HireLifeScience (02/08/25)
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  • Senior Manager , Medicare Product…

    Point32Health (Canton, MA)
    …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Senior Manager of Product Implementation and Administration will have two main ... filings, new benefit implementation, and product/vendor management processes. The Senior Manager will support annual assessment of new product strategies by… more
    Point32Health (01/03/25)
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  • Manager , Actuarial Services…

    Healthfirst (NY)
    **Duties and Responsibilities:** + Monitor experience under Healthfirst's Medicare line of business. + Provide support for annual Medicare bids for all ... analysis and other ad hoc analyses. + Research, evaluate and analyze Medicare market landscape. + Analyze product and segment performance, incorporating both… more
    Healthfirst (02/06/25)
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  • Senior Manager of Medicare Pharmacy…

    CVS Health (Scottsdale, AZ)
    …are seeking a dynamic and experienced leader to join our team as a Senior Manager , overseeing a team of 10 auditors. This role is pivotal in conducting and building ... Medicare Pharmacy Audit programs for our PBM clients. The...the unique needs of our clients. As the Senior Manager , you will be responsible for developing and implementing… more
    CVS Health (01/15/25)
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  • Manager Medicare DSNP, Care…

    AmeriHealth Caritas (Newtown Square, PA)
    …**Responsibilities:** Under the supervision of the Director of Care Management, the Manager of Care Management is responsible for the direct performance of Case ... Management Responsible for compliance with State and Federal laws and business plan...Directs the case management activities to comply with the Medicare Model for case management. 6. Develop and recommend… more
    AmeriHealth Caritas (02/04/25)
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  • Manager , HCS Clinical Policy…

    Molina Healthcare (Columbus, OH)
    …of clinical guidelines. + Facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and ... collaboration to enhance the continuity of care + Functions as hands-on manager responsible for supervision and coordination of enterprise clinical policy to drive… more
    Molina Healthcare (02/14/25)
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  • Medicare Pharmacy Coordinator

    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 ... under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare more
    Medical Mutual of Ohio (12/20/24)
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  • Medicare MAP Advisor

    Centers Plan for Healthy Living (Staten Island, NY)
    Medicare MAP Advisor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #266 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ... they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and...performing all required tasks assigned by the Sales Field Manager . Incumbent will be responsible for educating and enrolling… more
    Centers Plan for Healthy Living (12/03/24)
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  • Associate Medicare Retention Programs

    Healthfirst (NY)
    **Duties & Responsibilities:** Support Medicare Retention Manager in overseeing and measuring a broad range of existing Medicare customer retention ... Activities including assignment, monitoring and measurement of both Core Product, Medicare Cost Savings and Age-In outreach programs Manage current Involuntary… more
    Healthfirst (01/29/25)
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  • Appeal Analyst Pharmacy Medicare

    Corewell Health (Grand Rapids, MI)
    …administer all steps of the Pharmacy appeal and review processes for all Medicare products in a pleasant and expedient manner to ensure quality customer service ... and compliance with all legislative, regulatory and accreditation requirements. Assist...the member appeal and ALJ hearing processes for all Medicare products to thoroughly investigate appeal requests, leveraging critical… more
    Corewell Health (02/13/25)
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  • Medicare Appeals Analyst

    Corewell Health (Grand Rapids, MI)
    …of the member appeal and fair hearing review processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... systems, and collaboration to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements. Assist… more
    Corewell Health (02/12/25)
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  • Senior Director Medicare Ops

    Banner Health (AZ)
    …a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), Association for Community Affiliated Plans (ACAP), and ... operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved 4. Sets strategic… more
    Banner Health (12/15/24)
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  • Quality Assurance Specialist III - Medicare

    CareFirst (Baltimore, MD)
    …claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports ... or GED. **Licenses/Certifications Preferred:** + ECA Certified Quality Assurance Manager **Experience:** + 5 years Auditing, Quality Assurance, Operations, Training,… more
    CareFirst (02/16/25)
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  • Senior Manager , Compliance

    LA Care Health Plan (Los Angeles, CA)
    Senior Manager , Compliance Delegation Oversight Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, ... the safety net required to achieve that purpose. Job Summary The Senior Manager , Compliance Delegation Oversight is a solutions-oriented, strategic thinker with… more
    LA Care Health Plan (01/04/25)
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  • Manager , Compliance Monitoring

    LA Care Health Plan (Los Angeles, CA)
    …Required Licenses/Certifications Preferred Certified Internal Auditor (CIA) Certified Regulatory Compliance Manager (CRCM) Certified HealthCare Compliance ... Manager , Compliance Monitoring Job Category: Administrative,...Experience with implementing or supporting the implementation of managed Medicare , Medicaid or commercial regulations. Equivalency: Completion of the… more
    LA Care Health Plan (01/04/25)
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  • Manager , USFHP Compliance - Remote

    Martin's Point Health Care (Portland, ME)
    …Position Summary The Manager , USFHP Compliance will assist the Director, Compliance and Medicare Compliance Officer (MCO) in ensuring Martin's Point ... and all other applicable Federal regulations. Under the direction of the Director, Compliance , the position will support the oversight and management of the … more
    Martin's Point Health Care (01/17/25)
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