- 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 Plan's … more
- US Tech Solutions (May, OK)
- …06+ months contract **Note:** + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. + ... **Job Description:** + As a Pharmacist Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- CVS Health (Chicago, IL)
- …role is primarily responsible for modeling pharmacy network contracting arrangements for Aetna's Medicare Part D business and providing actuarial support to ... financial projections/modeling. + Support development of pharmacy network assumptions for Aetna's Medicare Part D bids and forecasts. + Partner with the… more
- Health Care Service Corporation (Nashville, TN)
- …for driving delivery, contingency planning, business results, and strategic planning for Medicare Part D Pharmacy consisting of multiple programs, ... that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.… more
- Prime Therapeutics (Frankfort, KY)
- …cost effective delivery of service; design, develop, and implement annual operating budget and the Medicare Part D annual bid + Partner with stakeholders and ... healthcare industry and recognition for government program expertise; strong understanding of Medicare Part C and D rules and regulations + Exceptional… more
- Dignity Health (Phoenix, AZ)
- …and overseeing the compliance program for Medicare Advantage ( Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a ... **Job Summary and Responsibilities** **Job Summary:** The Medicare Compliance Officer (MCO) is responsible for developing, implementing,… more
- Corewell Health (Grand Rapids, MI)
- …adherence + Educate members on disease state and medication + Educate members on Medicare Part D benefits and drug coverage to increase understanding ... Pharmacy Intern, under the direct supervision of a licensed Medicare Quality pharmacist, will engage with Medicare ...licensed Medicare Quality pharmacist, will engage with Medicare members to improve medication adherence to Medicare… more
- US Tech Solutions (May, OK)
- …HAVE 6 months of experienced with Prior Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) ... experience. **Education:** + Pharm D . required with at least two years' experience as a pharmacist in Managed care environment. + Must have an active license in the… more
- Bristol Myers Squibb (Princeton, NJ)
- …will lead policy development and strategy related to drug pricing policy and legislation (eg IRA, Medicare Part D ) for BMS as a member of a highly ... objectives. + Analyze legislative and regulatory developments impacting the IRA and Medicare Part D and develop BMS positions. **Policy Research & Advocacy… more
- Health Care Service Corporation (Chicago, IL)
- …company that will invest in your professional development. **Job Summary** The Executive Director, Medicare Part D Actuarial will lead the actuarial function ... for Medicare Part D products, including Individual MAPD and PDP, with end-to-end accountability for product strategy, pricing, and financial performance. The… more
- Lifespan (Rochester, NY)
- …manage schedules, and implement strategies. . Public Education:Schedule presentations and outreach on Medicare , Part D , Advantage plans, and Medicare ... presentations. . Ensure counselors provide objective information on Medicare , Medigap, Advantage plans ( Part C, and...Advantage plans ( Part C, and drug plans ( Part D ). . Oversee volunteers' daily activities.… more
- Rhythm Pharmaceuticals (Boston, MA)
- …appropriate access and coverage for Rhythm's portfolio across key commercial self-insured employers and Medicare Part D payers. The Senior NAD will develop ... of payer engagement and strategic account management in the commercial self-insured and/or Medicare Part D channels. The position reports into the VP, Market… more
- Humana (Lincoln, NE)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements ... first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ( Part D & B). The Medical director work assignments involve… more
- US Tech Solutions (May, OK)
- **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… more
- US Tech Solutions (AZ)
- …months contract** **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… more
- CareFirst (Baltimore, MD)
- …activities. + Experience with developing and implementing clinical programs. + Experience with Medicare Part D and Medicaid guidelines and requirements. + ... programs including Maryland Medicaid, Dual Prime Special Needs Plan (DSNP), and Medicare Advantage products. This role has oversight of pharmacy staff and develops… more
- CVS Health (Hartford, CT)
- …+ Coordination and execution of Medicare Bid requirements for MAPD and Part D , including several rounds of non-benefit expense (NBE), audit requests, ... including financial modeling and data analysis + Experience in Healthcare, Medicare or Part D + Experience in Oracle/Hyperion/S4 **Education** + Bachelor's… more
- US Tech Solutions (May, OK)
- …availability could be required. **Experience:** + Prior authorization experience preferred. + Medicare Part D experience required + Previous pharmacy ... of experience although 2-5 years is preferred. **Skills:** + Prior Authorization + Medicare Part D **Education:** + Bachelor's Degree Required, Pharm D … more
- Trinity Health (Gaithersburg, MD)
- …and 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
- East Boston Neighborhood Health Center (Revere, MA)
- …annual MassHealth applications and Medicare Secondary Payers Surveys + Ensuring that all Medicare Part D YTD Explanation of Benefits are received and ... + Strong knowledge of MassHealth eligibility + Strong knowledge of the overall Medicare eligibility of Part A, B and D + Verifying all insurances prior to… more
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