- Humana (Lansing, MI)
- …on problems of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual...management and clinical programming + Represents Humana at all Pharmacy Medicaid meetings including those with the… more
- Molina Healthcare (WI)
- …policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management, Group/IPA ... medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. + Reviews quality… more
- Health Care Service Corporation (Richardson, TX)
- …Summary** This position is responsible for providing leadership and oversight of the Pharmacy function that supports Medicaid & Individual Markets lines of ... investments and ensure ROI **PREFERRED JOB REQUIREMENTS** **:** + Knowledge of Medicare / Medicaid /Individual & Family Market programs in relation to pharmacy… more
- Walmart (Bentonville, AR)
- …negotiations, including medical benefit, physician, and value-based care agreements across Medicaid , Medicare , Commercial, and Exchange lines of business. + ... **Position Summary ** As Director , Payer Programs (Rx Clinical Services), you will..., Payer Programs (Rx Clinical Services), you will lead pharmacy clinical services contracting and payer relationship development to… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and ... managed care benefit plans and strong knowledge of government program contracts ( Medicare and Medicaid ) and benefits, preferred. + Strong written and… more
- Prime Therapeutics (Jefferson City, MO)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director , Pharm Trade Relations leads a team of ... every decision we make. **Job Posting Title** Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr...the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies,… more
- Abbott (Washington, DC)
- …Payment Systems, o Ambulatory Surgery Center payment systems, o Physician payments, o Pharmacy payments/processes o Medicare quality systems, o the Center for ... in the Government Affairs function. As the Government Affairs Director for Corporate Reimbursement, you will develop, lead and...policy **Preferred Qualifications** * Experience in the Centers for Medicare and Medicaid Services (CMS) or Health… more
- Mount Sinai Health System (New York, NY)
- **Job Description** Under direct supervision of the Director of Specialty Pharmacy , the Specialty Pharmacy Manager and the Specialty Pharmacy Clinical ... procurement of financial assistance for patients with government-sponsored health plans including Medicare , Medicaid and TriCare. Preferred: 3 years of health… more
- Trinity Health (Maywood, IL)
- …of Public Health (IDPH), The Centers for Medicare & Medicaid Services (CMS), and other licensing/accrediting agencies. PHARMACY SYSTEMS: Facilitate ... through the use of safe, cost-effective drug therapies. Work with the Director of Pharmacy Services to improve pharmacy processes, systems, and budgetary… more
- CVS Health (CT)
- …"base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. * ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...Two (2) + years of experience in managed care ( Medicare and/or Medicaid ) MD or DO; Board… more
- University of Colorado (Aurora, CO)
- …for reporting to leadership and the board. + Coordinates and submits annual Medicare and Medicaid cost reports, quarterly audit and reporting requirements, and ... management. + Healthcare Industry Knowledge: Understanding of payment reform, Medicare , Medicaid , private insurance regulations, and healthcare operations.… more
- Prime Therapeutics (Hartford, CT)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to ... every decision we make. **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account ...+ Knowledge of the applicable line of business (eg, Medicare , Medicaid , Exchange, Commercial, Employer Group) Every… more
- CVS Health (IL)
- …(PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare / Medicaid ) programs and individual client requested coverage determinations ... Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM… more
- Gentiva (Fairfax, VA)
- …knowledge of hospice principles, industry standards, regulations, and best practices ( Medicare , Medicaid , JCAHO, ACHC) + Expertise in nursing practice ... and office staff + Oversee budgeting and management of pharmacy , DME, labor, and supply costs **About You** **Specialized... Director of Clinical Services jobs, Hospice nurse director , Hospice compliance RN, and Medicare Hospice… more
- Walmart (Washington, DC)
- …regulations related, but not limited, to employer-sponsored insurance plans, reimbursement systems, Medicare , Medicaid , and pharmacy operations. + Lead ... ** Walmart is seeking a strategic, experienced, and mission-driven Director of Federal Government Affairs to lead our advocacy...health plans, PBM dynamics) and traditional health policy areas ( Medicare , Medicaid , pharmacy , and broader… more
- Ascendis Pharma (Princeton, NJ)
- …Oversee the administration of rebate programs, including government rebates (eg, Medicaid , Medicare ), managed care rebates, and commercial rebates. Ensure ... models, and contracting strategies across various payer segments (eg, commercial, Medicare , Medicaid ). + Excellent negotiation, communication, and interpersonal… more
- Atlantic Health System (Morristown, NJ)
- …safety grade - its highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its highest five-start rating ... and training programs for new employees, current employees, students, and pharmacy residents. Maintains professional competency by keeping abreast of current… more
- Bristol Myers Squibb (Princeton, NJ)
- …Market Access technical expertise (ie, coding, reimbursement and payer policies related to Medicare , Medicare Part D, Medicaid , and private insurance) to ... their personal lives. Read more: careers.bms.com/working-with-us . **SUMMARY:** The Associate Director , PASS Program Strategy and Marketing will play a critical role… more
- Atlantic Health System (Morristown, NJ)
- …safety grade - its highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its highest five-start rating ... Education/Experience 1. High School Diploma or equivalent required 2. Hospital Pharmacy experienced preferred 3. PTCB or NHA certification active or acquire… more