- Centene Corporation (Phoenix, AZ)
- …Pharmacy Service Center, Medicare Part D / Part B, Appeals, Medicare Part D Operations and State Health Programs Pharmacy Operations or ... with Clinical Pharmacists or Regional Medical Director on related issues. + Prior Authorization Medicare Part D and Part B + Tracks and triage coverage… more
- 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... + Support vendor relationships (eg Plan Sponsor), daily operations , and implementation of EGWP pharmacy programs + Understand… more
- Healthfirst (NY)
- … Clinical Programming and Operations , Provider Performance, Medical and Pharmacy Part D cost savings, and Medicare Star Ratings/member experience. ... Programming and Operations + Provider performance + Medical and Pharmacy Part D cost savings + Medicare Star Ratings/member experience. **Compliance &… 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
- Central Maine Medical Center (Lewiston, ME)
- …the Nursing Director, the Nurse Leader is responsible for the day-to-day operations of assigned responsibilities and is accountable for assuring the consistent use ... 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… more
- UCLA Health (Los Angeles, CA)
- …Healthcare, or a related field required. + Five or more years of experience in a Medicare Advantage and Part D Managed Care compliance role is required. + ... processes that maintain essential elements of our compliance efforts within the Medicare Advantage program. In this role, you'll oversee policy and procedure… more
- The Cigna Group (Nashville, TN)
- … Operations . + Responsible for analysis and interpretation of moderate to complex Medicare Part C and D financial information. Utilizes independent ... (BFO), supporting the Midwest and MidAmerica markets of our Medicare Advantage business. We are seeking a creative and...able to lead and delegate responsibilities as needed + Medicare Advantage experience and general knowledge of the healthcare… more
- Catholic Health Initiatives (Bismarck, ND)
- …basis as required for Medicare Part B and Medicare Part D . + Actively participates in retail pharmacy operations . + Maintaining confidentiality ... throughout western and central North Dakota. CHI St. Alexius Health is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing… 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 ... Job Description BUSINESS UNIT: MMM Holdings, LLC DEPARTMENT: Service Operations Department - Call Center POSITION: Customer Service Representative...their covered Part D drugs. Orlando Family Physicians, a… more
- Prime Therapeutics (Columbus, OH)
- …information, responding to questions and resolving complex problems and issues. + If supporting Medicare Part D , will be responsible for implementing CMS ... understanding of operating infrastructure of Strategic Business Unit(s) (SBUs) operations to be able to proactively analyze and identify...Big 4 public accounting experience. + For roles supporting Medicare Part D : Medicare… more
- The Cigna Group (Nashville, TN)
- …Patient Assistance Programs and/or experience as a supervisor/manager a plus. + Knowledgeable with Medicare , Medicare Part D benefits, and Stars Program. ... **Job Summary:** The Operations Supervisor is responsible for the daily activities...applications, tracking applications and refills for patient care. The Operations Supervisor will be responsible for a wide variety… more
- The Mount Sinai Health System (New York, NY)
- …methodologies. c. Collects, organizes, integrates, analyzes and interprets data. d . Leverages advanced statistical analysis methods to create insightful ... to focus their efforts to maximize contract performance and clinical effectiveness. d . Quality and Documentation Helps to link payer quality and documentation… more
- Takeda Pharmaceuticals (Boston, MA)
- … Part B regional carriers, Medicare Part C managed care, Medicare Part D drug plans, all third party commercial payer, including health ... and in-depth knowledge in obtaining reimbursement with third party commercial payers, Medicare Parts D and B, Medicaid, VA/DOD, integrated payer healthcare… more
- Lumeris (IL)
- …you for your interest in Lumeris. **Position:** Director Physician Partner Operations **Position Summary:** Oversees delivery management for Lumeris partners to ... outcomes for health system and provider accounts. Oversees and owns operations for health system customers. **Job Description:** **Primary Responsibilities** +… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer ... Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare...discount program, impose inflation rebates for Part B and Part D … more
- CVS Health (Northbrook, IL)
- …infrastructure to establish a new department supporting invoicing and accounts receivable management for Medicare Part D members utilizing the Medicare ... Reinstatements, Balancing/Reconciliations/Out-of-Balance Research, Disputes, and Cash Application. M3P is a Medicare Part D requirement effective January 1,… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer ... Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Information Technology...discount program, impose inflation rebates for Part B and Part D … more
- AdventHealth (Tavares, FL)
- …Clinical Ladder Program **Our promise to you:** **Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in ... is a registered professional nurse who supports the Nurse Manager in overall operations of their assigned unit.** **Is able to demonstrate critical thinking skills,… more
- AdventHealth (Tavares, FL)
- …Clinical Ladder Program* **Our promise to you:** Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in ... professional nurse who supports the Nurse Manager in overall operations of their assigned unit. Is able to demonstrate...competency in care delivery. Develops staff preceptors and mentors. d . Assures diversity of staff is positively fostered in… more
- Marshfield Clinic (Eau Claire, WI)
- …Service Line Medical Director - Hematology/Oncology **Cost Center:** 301081251 Systems Operations **Scheduled Weekly Hours:** 4 **Time Type:** Part time ... service line physicians c. Annual review of Advanced Practice Clinicians d . Market share/specialty planning, including outreach e. Budget and financial performance… more