- 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
- 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 CVS ... **Job Summary and Responsibilities** **Job Summary:** The Medicare Compliance Officer (MCO) is responsible...as needed, detailing the status of Mercy Care Plan's Medicare Compliance Program implementation, identification and resolution… 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 ... 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
- Trinity Health (West Springfield, MA)
- … with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of ... Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director, Quality Improvement and Compliance , in collaboration with… 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
- BrightSpring Health Services (Bowling Green, KY)
- …the benefits of Original Medicare (Parts A and B) with prescription drug coverage ( Part D ). The Abilis Health Plan is a unique plan allowing members to ... approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct… more
- Hartford HealthCare (Farmington, CT)
- …what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. The creation of the HHC System ... guidelines, keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or third-party payers, responsible for Epic… more
- Centene Corporation (Austin, TX)
- …knowledge of compliance laws and regulations, specifically related to Medicare , D -SNP, and applicable state regulations._** **Position Purpose:** Partners ... and SMAC regulatory filings. + Manages Duals (and Medicare with D -DSNP specific or separate) compliance reporting responsibilities and respond to inquiries… 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
- 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
- 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
- Humana (Denver, CO)
- …on rules, regulations and sub-regulatory guidance that apply to Insurance Products (ie, Medicare Advantage, Part D , Group Specialty, and Individual ... **Become a part of our caring community and help us...Specialty), licensure or corporate structure. The Insurance Product Compliance Lead works on problems of diverse scope and… 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
- 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
- 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...actionable recommendations for product design, pricing strategy, and long-term Medicare positioning. Audit, Governance & Compliance *… 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