- 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …years directly involved in Medicare Advantage or Part D auditing activities. **Professional Certification** . Certified Compliance and Ethics ... and all compliance -related activities for the Company's Medicare Advantage ( Part C) and Prescription Drug... Advantage ( Part C) and Prescription Drug ( Part D ) health plan programs. Ensures that… more
- Medical Mutual of Ohio (OH)
- …supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part ... administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical… more
- Banner Health (TX)
- …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 ... is in place for accurate, complete, and compliant for Medicare Advantage Parts C & D . +...a timely fashion. + Working in start-up environment + Medicare Advantage Compliance training, audits, regulations, and… more
- CVS Health (New Albany, OH)
- …competitive intelligence to guide, consult and drive product implementation and strategic focus for Medicare Part D and Medicare Advantage. + Develops ... personal, convenient and affordable. **Position Summary** In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local … more
- CVS Health (Columbus, OH)
- …compliance and client profitability. **Required Qualifications** + 5+ years experience with Med D or EGWP data, Medicaid or Medicare Data preferred + 7+ years ... problems, and present recommendations to FEP leadership. As a part of FEP Account Team, he/she will be responsible...healthcare **Preferred Qualifications** + 5+ years experience with Med D or EGWP data, Medicaid or Medicare … more
- CVS Health (Hartford, CT)
- …working in a fast-paced environment with constant change Preferred Qualifications + Prior Pharmacy, Medicare Part D , Medicare or Medicaid experience + ... actuarial team supporting CVS Health and Aetna's Government Services Medicare Advantage and Prescription Drug Plan business. The position...position will provide modelling and analytical support for the Part D Business, with a focus on… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… more
- Central Maine Medical Center (Lewiston, ME)
- …staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… 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 ... and Appeals Learning Advocates and management team as needed. + Must maintain compliance at all times with CMS and department standards. + Position requires schedule… 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) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition… more
- Healthfirst (NY)
- …experience + Academic detailing experience + Medicare Part D formulary management + Data analytics experience ** Compliance & Regulatory ... implement comprehensive, provider-specific plans to increase quality ratings for pharmacy specific Part D Patient Safety and HEDIS measures. + Effectively… more
- Takeda Pharmaceuticals (Exton, PA)
- …integrity, and timeliness of all monthly/quarterly rebate payments for all Commercial and Medicare Part D contracted customers. This thorough process ... II, you will perform calculations and generate payments in compliance with executed reimbursement Agreements. Function as a rebate...with Senior Analyst(s) in support of all Commercial and Medicare Part D internal/external audits… more
- City of New York (New York, NY)
- … Medicare 's preventive services. New York State certified counselors provide assistance with Medicare Part D prescription plan selection, Medicare ... - Ensure compliance with local, state, and federal regulations, including Medicare and Medicaid policies. - Collaborate with program leadership to develop and… more
- Highmark Health (Pittsburgh, PA)
- …collaborative team responsible for the development, implementation, and maintenance of our organization's Medicare Part D formularies and Medicare ... to federal and CMS requirements. The role requires a deep understanding of Medicare Part D regulations, including the implications of the Inflation Reduction… more
- CVS Health (Scottsdale, AZ)
- …affordable. **Position Summary** As a Senior Financial Analyst, you will support the Medicare Part D Employer Group Waiver Plans billing/reconciliation team ... support the new client's post go-live for reeducation purposes, compliance , and various audit requests. You will work directly...same time. This opportunity is with the CVS Health Medicare Part D business and… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …of business. + Develop, refine, implement, and pull through the MTPA contracting strategy for Medicare Part D , PBMs, GPOs and Commercial + Manage all Payer ... and external groups including Commercial Payers, Medicare , Medicare Advantage plans, Part D ,...strategies. + Works with cross-functional partners (Commercial, Medical, Legal, Compliance and others) to develop a comprehensive access and… more
- Marshfield Clinic (Eau Claire, WI)
- …Center:** 301081251 Systems Operations **Scheduled Weekly Hours:** 4 **Time Type:** Part time **Job Description:** **POSITION TITLE:** Assistant Service Line Medical ... service line physicians c. Annual review of Advanced Practice Clinicians d . Market share/specialty planning, including outreach e. Budget and financial performance… more
- Hackensack Meridian Health (Hackensack, NJ)
- …+ Recent hospital experience. + Knowledge of Pathophysiology and Disease Process. + Knowledge of Medicare Part A. + Familiar with Medicare Part B. ... the facility's Utilization Management/Review Committee for documentation completeness and compliance with patient status. Facilitates accurate documentation for severity… more