- Excellus BlueCross BlueShield (Rochester, NY)
- …Description: This pharmacist clinician is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes ... for the current and upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to the Plan's … more
- US Tech Solutions (May, OK)
- …06+ months contract **Note:** + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. + ... **Job Description:** + As a Pharmacist Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- CVS Health (Chicago, IL)
- …role is primarily responsible for modeling pharmacy network contracting arrangements for Aetna's Medicare Part D business and providing actuarial support to ... financial projections/modeling. + Support development of pharmacy network assumptions for Aetna's Medicare Part D bids and forecasts. + Partner with the… more
- Prime Therapeutics (Salem, OR)
- …cost effective delivery of service; design, develop, and implement annual operating budget and the Medicare Part D annual bid + Partner with stakeholders and ... healthcare industry and recognition for government program expertise; strong understanding of Medicare Part C and D rules and regulations + Exceptional… more
- Corewell Health (Grand Rapids, MI)
- …adherence + Educate members on disease state and medication + Educate members on Medicare Part D benefits and drug coverage to increase understanding ... Pharmacy Intern, under the direct supervision of a licensed Medicare Quality pharmacist, will engage with Medicare ...licensed Medicare Quality pharmacist, will engage with Medicare members to improve medication adherence to Medicare… more
- CVS Health (Hartford, CT)
- …and member/nonparticipating providers). * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in ... **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on part...Management Strategy support * Develop subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
- US Tech Solutions (May, OK)
- …HAVE 6 months of experienced with Prior Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) ... experience. **Education:** + Pharm D . required with at least two years' experience as a pharmacist in Managed care environment. + Must have an active license in the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …members Education and Experience: + Minimum 2-3 years of customer/member service experience + Medicare Part D and/or Pharmacy experience preferred + BS/BA or ... by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of, we' d love… more
- Centers for Medicare & Medicaid Services (Washington, DC)
- …and support on Medicare Part B and D prescription drug models, Medicare Part D operational activities, and/or Medicare Part D ... Research Analyst, GS-0101-14, you will provide technical expertise and guidance on Medicare Part B and D policy and payment issues; develop innovative… more
- Rhythm Pharmaceuticals (Boston, MA)
- …appropriate access and coverage for Rhythm's portfolio across key commercial self-insured employers and Medicare Part D payers. The Senior NAD will develop ... of payer engagement and strategic account management in the commercial self-insured and/or Medicare Part D channels. The position reports into the VP, Market… more
- Humana (Lincoln, NE)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements ... first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ( Part D & B). The Medical director work assignments involve… more
- US Tech Solutions (May, OK)
- **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… more
- US Tech Solutions (AZ)
- …months contract** **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… more
- US Tech Solutions (May, OK)
- …availability could be required. **Experience:** + Prior authorization experience preferred. + Medicare Part D experience required + Previous pharmacy ... of experience although 2-5 years is preferred. **Skills:** + Prior Authorization + Medicare Part D **Education:** + Bachelor's Degree Required, Pharm D … more
- State of Colorado (Denver, CO)
- …with associated paperwork, picking up pharmaceuticals and paperwork from the units, process Medicare Part D claims, coordinates pickup and removal of ... are as follow: Deliver medications to treatment units, fill prescriptions, process Medicare part D claims, and issue pharmaceutical credits back to clients:… more
- Trinity Health (Gaithersburg, MD)
- …and correct CMS return files, RAPS, and encounter data. + Ensure compliance with Medicare Part D reporting requirements and prepare annual bid submissions. ... Health PACE (TH PACE) programs. This role manages revenue cycles for Medicare , Medicaid, and private pay, oversees expense cycles including vendors and medical… more
- CVS Health (Harrisburg, PA)
- …for internal and external stakeholders. + Become a subject matter expert on select Medicare Part D Star measures. **Ideal Candidate Profile:** + Strong ... Medicare Product** to support the development, launch, and optimization of our Medicare Part - D product suite. This role is ideal for a strategic thinker… more
- US Tech Solutions (RI)
- …exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided ... where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government mandated… 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 through ... where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government mandated… more
- Prime Therapeutics (Columbus, OH)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** +… more
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