- General Dynamics Information Technology (NC)
- …to include weekends and holidays. Preferred Skills: + Familiarity with Medicaid, Medicare Part D , or PBM operations . Prior experience with call center ... operations or customer service roles a plus + Location: Hybrid + US Citizenship Required GDIT IS YOUR PLACE: + 401K with company match + Comprehensive health and wellness packages + Internal mobility team dedicated to helping you own your career +… more
- Prime Therapeutics (Washington, DC)
- …projects simultaneously **Preferred Qualifications** + Pharmacy Benefit Management/health care experience + Medicare Part D , Medicaid, and/or Affordable Care ... passion and drives every decision we make. **Job Posting Title** Compliance Analyst - Medicare Part B- REMOTE **Job Description** Job Description The Compliance… more
- Intermountain Health (Albany, NY)
- …Calls (Inbound/Outbound) + Oral Communication + Written Communication + Group Problem Solving + Medicare Part D + Medicaid + Mentorship/Coaching + Decision ... The Pharmacy Government Specialist II is responsible for the day-to-day operations of Government programs, providing superior customer service to all inquiries… more
- Central Maine Medical Center (Lewiston, ME)
- …the Nursing Director, the Nurse Leader is responsible for the day-to-day operations of assigned responsibilities and is accountable for assuring the consistent use ... staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes… more
- GEHA (Lee's Summit, MO)
- …Oversight & Performance Management** + Day to day management of the commercial PBM and Medicare Part D / EGWP administrator relationships for the FEHB and ... a nimble and efficient organization. The Director of Pharmacy Operations & PBM Management will guide and improve our...Health Benefits (PSHB) along with those for CMS for Medicare Part D / Employer… more
- Martin's Point Health Care (Portland, ME)
- …and state laws and regulations and applicable accreditation standards + Expert knowledge of Medicare Part D regulations + Proven skills developing high ... to Work" since 2015. Position Summary The Director Pharmacy & Quality Operations is responsible for the oversight and execution of comprehensive strategic planning… more
- UNC Health Care (Holly Springs, NC)
- …the Centers for Medicare and Medicaid Services (CMS). In addition, as part of the UNC Health Rex network, Holly Springs Hospital benefits from the collective ... **_Rex Holly Springs Hospital is proud to be a part of southern Wake County, offering residents and their...leader to join their leadership team to oversee Nursing Operations , along with Surgery, Pharmacy, Care Management, and Rehab… more
- Lumeris (New York, NY)
- …create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. ... **Position:** Senior Director, Partner Operations **Position Summary:** Provides executive leadership and oversight of...or similar degree + Experience in managed care and/or Medicare Advantage **Working Conditions** + While performing the duties… more
- City of New York (New York, NY)
- … Medicare 's preventive services. New York State certified counselors provide assistance with Medicare Part D prescription plan selection, Medicare ... (HIICAP) helps older adults navigate the complexities of all components of Medicare . HIICAP conducts public outreach presentations and workshops to older adults,… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Plan's Medicare Prescription Drug Program, including compliance and oversight of Medicare Part D laws, regulations and reporting requirements, benefit ... Perform medical necessity reviews for formulary exceptions and prior authorizations according to the Medicare Part D defined guidelines + Work with the… more
- Humana (Wright Patterson AFB, OH)
- **Become a part of our caring community and help us put health first** Humana Military, a wholly owned subsidiary of Humana Inc (A $100 billion, Fortune 38 market ... **Market Development Advisor** directs daily TRICARE service delivery and network operations to include customer support and outreach activities, network adequacy,… more
- Walgreens (Deerfield, IL)
- …able to address/understand/discuss complex reimbursement systems and flow of the healthcare dollar ( Medicare Part B/ D , ACOs, ASOs, GPOs, Hospitals, etc.). ... serves as a resource for other Account Managers, Field Operations , and plays a lead role on key region...experience with billing procedures for hospital, medical offices and Medicare (B / D benefits). + Experience… more
- Highmark Health (Camp Hill, PA)
- …and authority. + As a seasoned Group Retiree market expert ( Medicare Advantage, Medicare Supplement, Part D , Medicare Exchanges) this leader will ... and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as… more
- Walgreens (Deerfield, IL)
- …able to address/understand/discuss complex reimbursement systems and flow of the healthcare dollar ( Medicare Part B/ D , ACOs, GPOs, Hospitals, etc.). **Job ... variety of tools, and internal resources as an integral part of the sales interaction. + Leads cross functional...experience with billing procedures for hospital, medical offices and Medicare (B / D benefits). + Experience… more
- Sanofi Group (Washington, DC)
- …public response to specific US Health and Human Services government program regulations for Medicare Part D . This requires deep analysis of the material ... to access and reimbursement of Sanofi portfolio prescriptions in Health and Human Services Medicare Part D program. The role must engage with business… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …management firms. Convey's healthcare-focused teams help millions of Americans navigate the complex Medicare Advantage and Part D landscape. To learn more, ... ESSENTIAL DUTIES AND RESPONSIBILITIES * Collaborate with business leaders from Operations , IT, Product Development, Marketing, Sales and Finance to align pricing… more
- Endo International (Nashville, TN)
- …in the biologic (injectable) market. + Possess a strong understanding of commercial payers, Medicare Part B and D and Medicaid; particularly in assigned ... Each FRM should be an expert SP logistics and operations . + FRMs must be able to analyze data...regional MAC for all ENDO products. + Knowledgeable on Medicare billing/coding and appeal process. ASP, WAC as well… more
- VNS Health (Manhattan, NY)
- …one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Part D , or Select Health to ensure compliance ... dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals processes. You will...and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health product lines. *… more
- Molina Healthcare (New York, NY)
- …interventions that will improve CAHPS, HEDIS and HOS scores. Responsible for monitoring Part D and Operational health insurance metrics and coordinating with ... and federal QI compliance activities. Responsible for local execution supporting Medicare Stars strategies and performance improvement. **Work Location -** Within… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to maintain compliance with all regulatory requirements. + Support product portfolio, including Medicare Part D which includes rotational weekend and holiday ... providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D , Home...Care Dosing program implementation and management + Support Pharmacy Operations analysts in executing day-to-day approvals and denials in… more