- 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...client benefit. Aid internal teams to support clients and business partners. **Responsibilities** + Provide oversight of operational activities… more
- CVS Health (Hartford, CT)
- …Summary: Responsible for successful execution and delivery associated with leading large scale Medicare Part D product benefit implementation inclusive of ... builds and testing. + Minimum 3-5 years of solid Medicare Part D guidance &...preferred in an appropriate area of knowledge (eg, healthcare, business , IT, etc.)/specialized training/relevant professional qualification. + Prefer Master… more
- Humana (Columbus, OH)
- …data analytics skills and attention to detail **Preferred Qualifications** + Basic understanding of Medicare Part D + Prior experience with Microsoft Excel ... **Become a part of our caring community and help us...Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a… more
- CVS Health (Hartford, CT)
- …- 3 plus year of Coverage Determination & Appeals experience. - 1 plus year of Medicare PART B experience - MHK, RxClaim, and People Safe proficient. - Meeting ... **Position Summary** - Learning the rework queues for each line of business - Working rework reports timely - Researching and troubleshooting failed claims… more
- Medical Mutual of Ohio (OH)
- …a fully remote opportunity_** . **_Eastern & Central Time Zones preferred. Extensive Medicare Part D experience is highly sought after._** ... to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and...Medicare Pharmacy Coordinator I** . Associate Degree in Business Administration, Healthcare, or related field or equivalent combination… more
- Carle (Urbana, IL)
- …REQUIREMENTS Two (2) years experience in compliance or health insurance with previous Medicare Advantage, or Part D experience. SKILLS AND KNOWLEDGE ... for Medicare and Medicaid Services (CMS) related to the Medicare line of business . This position is responsible for development of member materials, and the… more
- Magellan Health Services (San Diego, CA)
- …Rx Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business . Performs follow-up to ensure reviews ... occur as scheduled and written reports are generated by Physician Clinical Reviewers (PCRs). Analyzes pending completion rate based on PA review due dates. Provides updates to relevant departments to ensure turnaround time compliance with accreditation and… more
- Elevance Health (Columbus, OH)
- …geographic regions and lines of business , requires substantial knowledge in the Medicare business as well as an understanding of the intricate workings of ... pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account...-Understanding of the benefit design and formularies, specifically for Part D . -Experience in a pharmacy benefit… more
- Banner Health (AR)
- …8:00 AM - 5:00 PM (AZ Time). In this position you will be monitoring Medicare Advantage Parts C & D operational control measures ensuring appropriate oversight ... that sounds like something you want to be a part of - apply today! Becker's Healthcare recently honored...is in place for accurate, complete, and compliant for Medicare Advantage Parts C & D . +… 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 ... anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory requirements… more
- CVS Health (Hartford, CT)
- …Drug Plan business . The position will provide modelling and analytical support for the Part D Business , with a focus on pricing, modelling, and bid ... technical skills and critical thinking to design and achieve business solutions + Demonstrate understanding of existing data sources...environment with constant change Preferred Qualifications + Prior Pharmacy, Medicare Part D , Medicare… more
- CVS Health (Blue Bell, PA)
- …focus on developing cost trend projections and evaluating the drivers of emerging results for Medicare Part D - including MAPD, SNP, and PDP products. The ... colleague will work with business partners to lead analysis, reporting, and process development...attention to detail **Preferred Qualifications** + Previous Pharmacy or Medicare Part D experience +… more
- US Tech Solutions (May, OK)
- …requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided through ... requires schedule flexibility and additional cross training to learn all lines of business . + Flexibility for movement to different parts of the business … more
- Intermountain Health (Murray, UT)
- …of all medication therapy management programs for Medicare Part D , Medicaid, Commercial lines of business and medical homes. Provides direct support ... changes needed to provide cost-effective quality pharmacy benefits to members. Schedule Regular business hours 8-5. Position can be remote with some time required in… more
- Intermountain Health (Murray, UT)
- …of all medication therapy management programs for Medicare Part D , Medicaid, Commercial lines of business and medical homes. Provides direct support ... changes needed to provide cost-effective quality pharmacy benefits to members. Schedule Regular business hours 8-5. Position can be remote with some time required in… more
- Humana (Columbus, OH)
- …+ Lead actuary owns responses related to Part B pharmacy projection and Part D bid base period development. + Coordinates with data suppliers and compliance ... ranging from moderate to substantial. Part B Pharmacy Pricing **Lead Actuary** Part B Pharmacy Pricing + Own the Medicare Advantage (MA) Individual and… more
- Humana (Columbus, OH)
- …state relationship management, optimizing Medicaid performance and ensuring alignment with Medicare and other Enterprise leaders. **Unified D -SNP Market ... **Become a part of our caring community and help us...large-scale organization. + Proven ability to lead complex, multi-state Medicaid/ Medicare markets and drive consistent execution of business… more
- Humana (Columbus, OH)
- …to exercise independent judgment and thinking on complex issues **Preferred Qualifications** + Medicare Advantage and/or Part D experience + Demonstrated ... **Become a part of our caring community and help us...the Senior Products Actuarial Compliance team focused on special Medicare Advantage programs, including Value Based Insurance Design (VBID),… more
- G-TECH Services, Inc. (Detroit, MI)
- …dashboard. * Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans. * Receive and respond to plan ... discussions. * Supports PBM audit and analytics to support Medicare pharmacy services business team. * Builds...Required Skills * Working knowledge of Medicare Part B and Part D … 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 ... 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