- Molina Healthcare (Long Beach, CA)
- …prompt and appropriate outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence ... Preferred Education Ambulatory Care Residency Preferred Experience Experience with Medicaid and/or Medicare programs. Preferred License, Certification,… more
- Molina Healthcare (Long Beach, CA)
- …medical director , and quality improvement staff. Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. Reviews quality ... medical policy/procedure development, provider contracting experience. Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management,… more
- UnitedHealth Group (Minneapolis, MN)
- …a difference at UnitedHealth Group and our family of businesses in serving our Medicare , Medicaid and commercial members and plan sponsors. Be part of changing ... improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel...leader. We are currently seeking a Utilization Management Medical Director to join our Clinical Performance team. This team… more
- Signature HealthCARE, LLC (Radcliff, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified ... a row and Modern Healthcare's "Best Places to Work!" Overview The ideal Director of Nursing Candidate is very detailed orientated, organized, great knowledge of… more
- ISNP (Lake Oswego, OR)
- …concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations Ensuring that all ... improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel...Clinical Services Manager (CSM), Clinical Team Lead (CTL) or Director of Clinical Operations (DCO) to enhance clinical expertise… more
- 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
- Humana (Hartford, CT)
- …We are seeking an experienced and strategic leader to fill the position of Director of Internal Pharmacy Forecasting and Performance Analytics. This role will ... of five direct reports and 1-2 indirect reports. The Director will play a key role in driving business...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- CVS Health (Scottsdale, AZ)
- …Landscape + Strong understanding of Health Plan Payers and associated lines of business- Medicaid , Medicare , Commercial, Exchanges + Passion for Health Care: A ... with heart, each and every day. As the Lead Director of Market Conduct Exams for the Network Services...experts (SME) representing all operational areas within the Retail Pharmacy Network Services division of CVS Caremark. This will… more
- CareFirst (Baltimore, MD)
- …make strategic choices in collaboration with the business sponsor. + Expertise in Medicare , Medicaid , and Commercial pharmacy operations. + Experience ... **Resp & Qualifications** **PURPOSE:** The Pharmacy Strategy Director is responsible for leading the day-to-day operations, performance, and oversight of … more
- Molina Healthcare (Atlanta, GA)
- …business objectives. Manage for all Medicare lines of business the annual Medicare and Medicare - Medicaid Plan Applications and Plan Benefit Package ... for the development and editing of core beneficiary communications, to include the Medicare Provider and Pharmacy Directories, Summary of Benefits and Annual… more
- AmeriHealth Caritas (Southfield, 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
- Molina Healthcare (Savannah, GA)
- …prompt and appropriate outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence ... **Preferred Education** Ambulatory Care Residency **Preferred Experience** Experience with Medicaid and/or Medicare programs. **Preferred License, Certification,… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- …unique business segments such as specialty and retail pharmacy and state Medicaid organizationsThe Sr. Director is a cross-functional leadership role that is ... Description: The Senior Director of Market Access Strategy is responsible for... benefit formularies, across all lines of business (Commercial, Medicare , & Managed Medicaid ), as well as… more
- Marshfield Clinic (Marshfield, WI)
- …of the SHP pharmacy benefits. This individual works closely with the Pharmacy Director , Clinical Pharmacy Specialist, and Operations Manager to provide ... have been or be excluded from participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must… 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
- 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
- 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
- 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
- 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
- AssistRx (Orlando, FL)
- …comply with all federal, state, and industry regulations, including anti-kickback statutes, Medicare / Medicaid rules, FDA and OIG guidance. + Work closely with ... with pharmaceutical manufacturers and understanding of third-party payer systems (commercial, Medicare , Medicaid ). Skills & Competencies: + . Strong leadership… more
