- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... contract **Note:** + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. + **Shift… more
- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- US Tech Solutions (AZ)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- Ankura (New York, NY)
- …and statistical methods; prescription drug claims submission and payment; pharmacy benefit administration; Medicare Part D compliance ; and the ... the issues associated with complex disputes, investigations, regulatory and compliance , and technology services. Our practice professionals have a thorough… more
- 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… 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 ... objectives are met and/or exceeded; instill a culture of compliance , accountability, and superior service within the Government Programs...and recognition for government program expertise; strong understanding of Medicare Part C and D … more
- Humana (Jacksonville, FL)
- …must live in the designated territory to effectively serve their local community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work ... **Become a part of our caring community and help us...The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role,… more
- Centene Corporation (Austin, TX)
- …and SMAC regulatory filings. + Manages Duals (and Medicare with D -DSNP specific or separate) compliance reporting responsibilities and respond to inquiries ... working knowledge of laws and/or regulations in area of compliance , in particular Medicare , D -SNP,...other job-related factors permitted by law, including full-time or part -time status. Total compensation may also include additional forms… more
- Centene Corporation (Austin, TX)
- …and delivering compliance training and education required + Experience with D -SNP SMAC, regulatory requirements and/or operations required + Medicare managed ... candidate will have:_** + **_Knowledge of Dual contract requirements (eg, Medicare -Medicaid plans)_** + **_Experience managing external audits and communicating with… more
- Atlantic Health System (Morristown, NJ)
- …organizational privacy, information governance, and data risk classification; (iv) accountable care organization compliance ; (v) Medicare C & D / Medicare ... Compliance and Privacy Manager oversees, in pertinent part , the following compliance risk areas: (i)... Compliance guidance and regulatory requirements; and (vi) Medicare C & D / Medicare Advantage… more
- Trinity Health (Gaithersburg, MD)
- …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
- UCLA Health (Los Angeles, CA)
- …Triennial Review, pre-delegation reviews, and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with ... as a Compliance Auditor, MAPD, focused on Medicare Advantage ( Part C) and Prescription Drug...desired. + 5 or more years of experience in Medicare Advantage or Part D … 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 ... career? Come build the future of pharmacy with us. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal is… more
- Ankura (NC)
- …firm or large to mid-size consulting firm in the payer and government programs ( Medicare Advantage and Part D , ACA, Medicaid, etc.) with experience ... working knowledge of laws, regulations and industry trends impacting compliance ( Medicare , Medicaid, ACA, government programs) and...projects for national health plans. Growth: You will be part of a group that is pursuing internal and… more
- LA Care Health Plan (Los Angeles, CA)
- …care. Ability to prioritize caseload. Knowledge of community resources. Knowledge of Medi-Cal and Medicare regulations. Ability to work as a part of a diverse ... Care Management Specialist II, D -SNP Team (12 month Assignment) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position… more
- Hospice Of San Joaquin (Stockton, CA)
- … Report for the Board of Directors. w) Ensure the EMR system maintains compliance with changing Medicare Conditions of Participation and the Joint Commission's ... everything we do. We seek a Dynamic, self-motivated Director of Quality and Compliance who thrives in a fast-paced environment and supports our mission. JOB SUMMARY… more
- Prime Therapeutics (Boston, MA)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The … more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Financial Compliance Audit, $10,000 SIGN ON BONUS Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... the safety net required to achieve that purpose. Job Summary Manager, Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role is responsible for… more
- Humana (Lincoln, NE)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements ... Medical Director relies on broad clinical expertise to review Medicare drug appeals ( Part D ...policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included… more
- MetroLink (Los Angeles, CA)
- …Engineer, Design and Standards, who will support the design and ensure compliance with SCRRA design criteria, standards, and specifications of all tracks, civil, ... are encouraged to apply immediately. DISTINGUISHING CHARACTERISTICS This classification is not part of a job series SUPERVISION EXERCISED AND RECEIVED + Receives… more