- D-H Lebanon-MHMH (Keene, NH)
- …based care for all patients served by the department. Assures compliance with national standards, professional and regulatory guidelines that govern patient ... for Disease Control and Prevention, Joint Commission, Centers for Medicare & Medicaid Services) Provides oversight for department quality...needs of the individuals and communities we serve. Being part of the Dartmouth Health family enables us to… more
- TriHealth (Cincinnati, OH)
- …all contracts into required systems/vendors, and managing the provider manual; Lead all Medicare Part D operations, including managing PBM and pharmacy ... Develop and maintain effective monitoring programs for claims processing, enrollment reconciliation, Medicare Part D , RAPS, and Encounter Data submissions;… more
- Mindlance (Nashville, TN)
- …*Knowledge of MultiPlan offerings and Medicare product types. Understanding of Medicare Advantage, Part D , and Supplemental Plan structures EEO: ... Job Type: Contract Position Summary: We are seeking a detail-oriented and compliance -focused Medicare Marketing Material Reviewer to support the review and… more
- Martin's Point Health Care (Portland, ME)
- …of incurred but not reported claims (IBNR). Prepare and analyze monthly estimates for Medicare Part D settlement estimates. Develop and maintain knowledge ... and support to the company, including responsibility for the actuarial support of Medicare product bids, US Family Health Plan (USFHP) rate negotiations with the… more
- Home Services Unlimited (Indianapolis, IN)
- …Summary Home Services Unlimited is one of Indy's most established independent Medicare -certified agencies. We are seeking an experienced home health nurse to serve ... providers. We currently are seeking a Full-Time RN Case Manager (or Part -time) to perform assessments, provide direct nursing care and develop, implement and… more
- Syneos Health Careers (Houston, TX)
- …information to HCP on how the products are covered under the benefit design (Commercial, Medicare Part D , Medicaid) Support patient access to the product by ... are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements. At Syneos Health, we believe in providing an… more
- ECMC (Buffalo, NY)
- …as required. TYPICAL WORK ACTIVITIES: Performs all duties in accordance with Medicare , Medicaid, governmental and third party payer and patient self-pay billing ... guidelines, rules and regulations and ensures compliance with Health Information Portability and Accountability Act (HIPPA) regulations; Operates electronic billing… 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
- 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
- Prime Therapeutics (Oklahoma City, OK)
- …fuels our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** ... the coordination of benefits in the pharmacy program with Medicare Part D plans. Provides...and leadership skills that ensure successful Part D pharmacy operations and program compliance within… more
- CVS Health (Hartford, CT)
- …and Aetna's exciting and growing government services pharmacy business. The primary focus is the Medicare Part D product strategy and pricing of MAPD, SNP ... and PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ensure… more
- CVS Health (Hartford, CT)
- …do it all with heart, each and every day. Position Summary: The AVP, Actuary - Medicare Part D is responsible for analyzing and forecasting the financial ... internal and external cross-functional business issues. Preferred Qualifications: + Pharmacy and Medicare Part D experience strongly preferred Education: +… more
- Trinity Health (Gaithersburg, MD)
- … with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of ... time **Shift:** Day Shift **Description:** **Director, Quality, Improvement and Compliance ** **Location:** Trinity Health PACE of Montgomery County, Gaithersburg, MD… more
- CVS Health (Boston, MA)
- …Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance ... The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … and its related financial models, including Medicare FFS, Medicare Advantage, Medicare Part D , and Medicare supplemental coverage. + Advanced ... by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of, we' d love… more
- Healthfirst (NY)
- …and following up on outstanding deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including tracking ... reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal...review of the website with business owners and ensures compliance with regulatory requirements specific to annual Go to… more
- BrightSpring Health Services (Louisville, KY)
- …the benefits of Original Medicare (Parts A and B) with prescription drug coverage ( Part D ). The Signature Advantage 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
- Central Maine Medical Center (Lewiston, ME)
- …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 ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… more
