- Merck & Co. (North Wales, PA)
- …management accountsLTCNational and regional health plans and PBMs (Commercial, Managed Medicaid, Medicare Part D )The US Market Access Contracting Team ... business decisions.Ensure contract strategies are implemented effectively and in compliance with required obligations (eg, legal, financial).Responsible for … more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …business partners. **Responsibilities** + Provide oversight of operational activities of Medicare Part D /EGWP programs + Ensure compliance with CMS rules ... **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides… more
- US Tech Solutions (May, OK)
- …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
- UCLA Health (Los Angeles, CA)
- …field required. + Five or more years of experience in a Medicare Advantage and Part D Managed Care compliance role is required. + Three or more years ... and managing processes that maintain essential elements of our compliance efforts within the Medicare Advantage program. In this role, you'll oversee policy and… 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 (Chicago, IL)
- …and statistical methods; prescription drug claims submission and payment; pharmacy benefit administration; Medicare Part D compliance ; and the ... delivery services across the Firm. Practice Summary: The Healthcare Disputes, Compliance and Forensics practice focuses on assisting healthcare and life science… more
- Prime Therapeutics (Eagan, MN)
- …lead for key government program initiatives including premium billing and Medicare Part D reporting and compliance . + Recommend operational improvements ... and presentation of financial KPIs for new and emerging Government program projects related to Medicare , Medicaid, and Medicare Part D . + Finance… more
- Healthfirst (NY)
- …Medical and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. ** Compliance & Regulatory Responsibilities:** Noted above. ... Clinical Programming and Operations, Provider Performance, Medical and Pharmacy Part D cost savings, and Medicare Star Ratings/member experience. +… more
- CVS Health (Blue Bell, PA)
- …+ Solid technical/analytical skills and attention to detail Preferred Qualifications + Previous Pharmacy, Medicare Part D , Medicare experience + ASA or ... financial and business impacts of changes to the complex Part D market and completive landscape. The...a focus on pricing, modelling, and bid development and compliance activities for MAPD, SNP and PDP products. The… 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
- CVS Health (Harrisburg, PA)
- …Summary** Directs the formulation, implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the ... years of Managed Care experience in health plan and/or PBM roles 15+ years Medicare experience **Education** Pharmacist, BS or Pharm D with active, unrestricted… more
- CVS Health (Chicago, IL)
- …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
- CVS Health (Chicago, IL)
- …SNP and PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ... technical/analytical skills and attention to detail Preferred Qualifications + Previous Pharmacy or Medicare Part D experience + FSA designation + Experience… 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
- InnovaCare (Ponce, PR)
- …members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to ... our organization.* Visits and evaluates POS (booth) to identify compliance issues or Marketing needs.* Supports and recruitment, hiring...their covered Part D drugs. Orlando Family Physicians, a… more
- InnovaCare (San Juan, PR)
- …members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to ... health assessment.o Notifies supervisor of any processes not in compliance with the SNP's policies and MOC requirements.o If...their covered Part D drugs. Orlando Family Physicians, a… more
- InnovaCare (San Juan, PR)
- …members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to ... Staff will notify supervisors of any processes not in compliance with the Plan's SNP policies and MOC requirements....their covered Part D drugs. Orlando Family Physicians, a… more
