- Novo Nordisk Inc. (Plainsboro, NJ)
- …accurately forecast gross to net components including but not limited to Managed Care, and Medicare Part D , Medicaid as well as current and future Healthcare ... data sources used in analyses, generating new insights Controls, Compliance and Finance Responsible for ensuring that all rebate...key rebate categories included but not limited to Commercial, Medicare Part D , Coverage Gap,… more
- Commonwealth Care Alliance (Boston, MA)
- …management, (c) coordination of onboarding and training of related CBO staff, ( d ) data review, reporting and analysis, and (e)assistance to these external partners ... and databases that CCA implements. - Working knowledge of Medicare and Medicaid (MassHealth) - Familiarity with and full...self-motivated, with the ability to work independently and as part of a team to meet departmental goals. -… more
- BeOne Medicines (Emeryville, CA)
- …managed markets, hospital markets, various sites of care, IV medications, injectables, orals and Medicare Part D , etc. + Ability to measure and analyze ... and administrative requirements in an efficient manner and will achieve full compliance with drug laws and regulations when representing BeOne's products to Health… more
- US Physical Therapy (Houston, TX)
- …referral sources, while attracting top talent who value the chance to be part of a personalized, community-centered environment. **Job Description** We are seeking a ... new CPT Codes + Review denial trends + Financial Class determination + Update Medicare Expected Amounts Annually + Review and update state WC and Auto Expected… 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, ... 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
- CVS Health (Hartford, CT)
- …we do it all with heart, each and every day. **Position Summary** The Divisional CFO for Medicare Part D and Medicare Supplement is responsible for the ... financial stewardship, regulatory compliance , and strategic direction of these two major business...+ Serve as the chief financial partner to the Medicare Part D and … more
- The Cigna Group (Bloomfield, CT)
- …is designed to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal ... role will assist in development of actuarial analyses for Medicare Part D business, including...Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting + Financial Reconciliation Modeling + Trend… more
- Centene Corporation (Austin, TX)
- …and SMAC regulatory filings. + Manages Duals (and Medicare with D -DSNP specific or separate) compliance reporting responsibilities and respond to inquiries ... working knowledge of laws and/or regulations in area of compliance , in particular Medicare , D -SNP,...other job-related factors permitted by law, including full-time or part -time status. Total compensation may also include additional forms… more
- Centene Corporation (Austin, TX)
- …and delivering compliance training and education required + Experience with D -SNP SMAC, regulatory requirements and/or operations required + Medicare managed ... candidate will have:_** + **_Knowledge of Dual contract requirements (eg, Medicare -Medicaid plans)_** + **_Experience managing external audits and communicating with… more
- Prime Therapeutics (Salem, OR)
- …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
- 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
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… 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
- 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
- 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
- Prime Therapeutics (Trenton, NJ)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal is… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us...us put health first** Humana Dual Fully Integrated (HMO D -SNP) is seeking a Compliance Professional to ... and strategize to remediate those risks. Humana's Illinois Market Compliance Department is the first line of defense for...of Insurance and Health and Human Services' Centers for Medicare and Medicaid Services (CMS). + Conducts internal audits… more
