- Novo Nordisk Inc. (Plainsboro, NJ)
- …Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance . External relationships include Customers as outlined in the Purpose of ... NNI, a self-starter who is self-led and keeps their manager up to date on progress and ensures no...regional accounts team on ACO approach with health plan, PBM and health system customers Evolve Customer Engagement Strategy… more
- Elevance Health (Norfolk, VA)
- ** PBM Compliance Manager (Claims Audit)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... employment, unless an accommodation is granted as required by law. The ** PBM Compliance Manager (Claims Audit)** is responsible for coordinating pharmacy … more
- CVS Health (Scottsdale, AZ)
- …agencies and their contracted auditing organizations. As a Senior Manager , PBM Market Conduct Exam Support within Corporate Compliance , you will: + ... heart, each and every day. **Position Summary:** The Corporate Compliance PBM Business Compliance Office...dynamic individual to join our team in a Senior Manager role. This position will perform highly complex support… more
- CVS Health (Scottsdale, AZ)
- …state regulatory agencies and their contracted auditing organizations. As a Manager , PBM Market Conduct Exam Support within Corporate Compliance , you will: + ... heart, each and every day. **Position Summary:** The Corporate Compliance PBM Business Compliance Office...+ 5-7 years of combined experience in a project manager / PBM role/Market conduct exam role. + Excellent… more
- AscellaHealth (Berwyn, PA)
- …specialty pharmacy and healthcare services organization, is seeking a Senior Relationship Account Manager for our Berwyn, PA location. The person in this role will ... new relationships and managing existing accounts within a pharmacy benefit management ( PBM ) or health plan environment. This position is crucial to delivering value… more
- CVS Health (Woonsocket, RI)
- …do it all with heart, each and every day. **Position Summary** As a Manager within the Enterprise Procurement Subcontractor Compliance & Risk department, you ... PBM Proposal teams in the development of RFP requests by supplying necessary compliance documentation and responses. + Collaborating with PBM Legal to update… more
- Prime Therapeutics (Oklahoma City, OK)
- …fuels our passion and drives every decision we make. **Job Posting Title** Manager Operational Compliance (Remote) **Job Description** The Manager ... and quality efforts to ensure the department is operating in compliance with regulatory and/or contractual obligations. This position ensures the appropriate… more
- State of Arkansas (Little Rock, AR)
- …Pulaski Anticipated Starting Salary: $118,399.01 Position Summary The Pharmacist will function as the PBM Division Manager . The PBM Division Manager ... and monitors all PBM -related complaints, licensing, and renewal activities. The Manager also oversees a small professional staff and serves as the Division's… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to day clinical ... Day to Day: + Partner with Clinical Pharmacy and PBM Clinical teams to assist with strategic planning, development,...in conjunction with the Operations Managers to ensure regulatory compliance with CMS Chapter 18, and NCQA guidelines +… more
- CVS Health (Columbus, OH)
- …do it all with heart, each and every day. **Position Summary** The ** PBM Data Analyst** performs prescription claim and accumulator audits, verifies policy coverage, ... assesses claim validity, and communicates with PBM ( _Pharmacy Benefit Manager_ ) vendors & client...overages. + Maintains electronic records, updates information, and ensures compliance with relevant policies and regulations. + Assists with… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …P&P meetings. + Responsible for business oversight of after hours delegation program with PBM to ensure compliance with all NCQA requirements and to monitor ... true colors to blue. The Role The Pharmacy Operations Manager plays a critical role in the management of...management, quality and production and reporting to ensure regulatory compliance and service excellence. Reporting to the Director, Pharmacy… more
- CVS Health (Springfield, IL)
- …or more years of experience in project management, audit or PBM insurance/healthcare experience. **Preferred Qualifications** Compliance experience. Risk ... be a part of a dynamic Client Audit team within our PBM group at Fortune 5 CVS Health?!! As a Manager Client Audit, you will assist primarily with day to day… more
- ChenMed (Miami, FL)
- …we need great people to join our team. The Lead, Pharmacy Credentialing Benefit Manager (PCBM) is responsible for leading the effort to secure licenses and permits ... of new dispensaries. The incumbent in this role works directly with PBM contract counterparts to successfully manage the credentialing and recredentialing of new… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …position or similar + Preferred: minimum of 1 year in a pharmacy benefit manager ( PBM ) setting with working knowledge of operations. **Special Conditions of ... **Overview** **Scope of Responsibilities:** Assist with regulatory and compliance matters within ProAct. **Job Summary:** Responsible for administrative tasks to… more
- Mount Sinai Health System (New York, NY)
- …Description** Under direct supervision of the Senior Specialty Clinical Pharmacist Manager , the Specialty Pharmacy Financial Access Manager supervises Financial ... contacts may include third party payers, accrediting bodies, insurance / PBM companies, government peer review organizations, accrediting bodies and referring… more
- Elevance Health (Norfolk, VA)
- …employment, unless an accommodation is granted as required by law. The **Implementation Manager Senior - PBM ** will be responsible for leading and/or planning ... **Implementation Manager Senior - Pharmacy Benefit Management** A proud...improvements to ensure continual, measurable improvement of implementation quality, compliance , and speed of execution. + Identifies project team… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. Position Summary: The Senior Manager , Legal Contracts participates in the development and fulfillment of market conduct ... examination or state and federal investigation requests in support of Caremark's PBM business. Evaluates market conduct matters and other regulatory requests and… more
- Highmark Health (Harrisburg, PA)
- …the pharmacy as well as the medical benefits. This job will have a strong compliance focus to ensure adherence to CMS turnaround times for ACA and MA members and ... pharmacy edits. + Ensures adherence to all regulatory and compliance guidelines (CMS, NCQA, DOH, etc.) as it pertains...years in managed care pharmacy and/or pharmacy benefit management ( PBM ) + 1 year in a leadership role with… more
- Amazon (Boston, MA)
- …representing Amazon pharmacy with key relationships for Pharmacy Benefit Managers ( PBM 's), Manage Care Organizations (MCO's) Health Insurers (Health Plans, and ... Basic Qualifications - 10+ yrs overall experience preferably in PBM , health insurance, pharmacy, business development, marketing, managed care, Medicaid,… more
- J&J Family of Companies (Titusville, NJ)
- …of America **Job Description:** We are searching for the best talent for a Manager , Financial Services and Solutions, to be located in Titusville, New Jersey or ... to help overcome challenges to fulfillment, on-boarding and adherence. The Manager , Financial Services and Solutions will manage patient support programs for… more
