- Health Care Service Corporation (Nashville, TN)
- …is responsible for driving delivery, contingency planning, business results, and strategic planning for Medicare Part D Pharmacy consisting of multiple ... quality deliverables on schedule + Healthcare acumen, Managed Care Organization, Pharmacy Benefit Manager, Medicare experience + Advanced analytical skills,… more
- US Tech Solutions (May, OK)
- …**Note:** + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. + **Shift Timing:** ... service experience. **Experience:** + **Previous pharmacy experience in Medicare Part D , PBM, Prior Authorization is required.** + Appropriate… more
- US Tech Solutions (May, OK)
- …of experienced with Prior Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. ... knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Management Team. + Obtains endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee. + Oversees ... is a program manager, who is responsible for all Medicare Part D formulary creation...Pharmacist. + Pharm. D . In lieu of a Pharm. D ., a Bachelors in Pharmacy is required… more
- Sumitomo Pharma (Lansing, MI)
- …Experience in pharmaceutical secondary analytics and financial modeling + Understanding of Commercial and Medicare Part D pharmacy benefit designs + ... base salary range for this role is $183,360 to $229,200. Base salary is part of our total rewards package which also includes the opportunity for merit-based salary… 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 ... other quality measures. Under the direct supervision of the Medicare Quality pharmacist, the pharmacy intern will engage Priority Health Medicare members… more
- US Tech Solutions (May, OK)
- …of experienced with Prior Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. ... knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Medicaid, Commercial Prior Authorization and Case… more
- US Tech Solutions (May, OK)
- …of experienced with Prior Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. ... and procedure. **Experience:** + Prior authorization experience required. + Previous pharmacy experience in retail or hospital preferred. + Appropriate state license… more
- US Tech Solutions (May, OK)
- …**Experience:** + Prior authorization experience preferred. + Medicare Part D experience required + Previous pharmacy experience in retail or hospital ... technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. +...2-5 years is preferred. **Skills:** + Prior Authorization + Medicare Part D **Education:** +… more
- CVS Health (Chicago, IL)
- …is primarily responsible for modeling pharmacy network contracting arrangements for Aetna's Medicare Part D business and providing actuarial support to ... projections/modeling. + Support development of pharmacy network assumptions for Aetna's Medicare Part D bids and forecasts. + Partner with the teams… 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 ... in the healthcare industry and recognition for government program expertise; strong understanding of Medicare Part C and D rules and regulations +… more
- CareFirst (Baltimore, MD)
- …activities. + Experience with developing and implementing clinical programs. + Experience with Medicare Part D and Medicaid guidelines and requirements. + ... and Medicare Advantage products. This role has oversight of pharmacy staff and develops and maintains collaborative relationships with clinical, administrative,… more
- Humana (Lincoln, NE)
- … Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and ... first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ( Part D & B). The Medical director work assignments involve… more
- Martin's Point Health Care (Portland, ME)
- …or non-dispensing role (ambulatory care, managed care, quality management). Knowledge + Knowledge of Medicare Part D , Stars, and HEDIS quality measures. + ... to Work" since 2015. Position Summary The Primary Care Pharmacy Technician supports integrated clinical pharmacy services...reports to identify patients with care gaps related to Medicare Stars, HEDIS, or value-based care measures. + Conducts… more
- University of Southern California (Los Angeles, CA)
- …knowledge and understanding of third-party claims billing, particularly rules and requirements for Medicare Part B DMEPOS and Medi-Cal. The Director of ... The USC School of Pharmacy is accepting applications for a Director of...federal and state laws and regulations. Required Credentials: + Pharm. D . + State of California Registered Pharmacist License +… 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 ... organizational objectives. + Analyze legislative and regulatory developments impacting the IRA and Medicare Part D and develop BMS positions. **Policy… more
- Health Care Service Corporation (Chicago, IL)
- …benefit design, formulary and pharmacy network strategies, and is responsible for Medicare Part D bid development and submission, quarterly forecasting, ... in your professional development. **Job Summary** The Executive Director, Medicare Part D Actuarial will...and bid audits. This position reports to the DSVP, Pharmacy Finance and Actuarial and serves as a key… more
- Chiesi (Boston, MA)
- …+ Good understanding of payer segments (Commercial, Medicaid, Medicare Part D & B, etc.), reimbursement, and Specialty Pharmacy data. + Excellent written ... and verbal communication skills, including the ability to synthesize data and deliver a clear overview of Market Access insights. + Strong analytical (qualitative and quantitative), strategic thinking, creativity & problem-solving skills. + Self-directed and… more
- Elevance Health (Denver, CO)
- …medication use quality improvement programs, analyzing pharmacy spend and trends, and Medicare Star Part D measures strongly preferred. + Experience ... **Be Part of an Extraordinary Team** CarelonRx is a...family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies,… 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