- Novo Nordisk Inc. (Traverse City, MI)
- …treatment of diabetes, obesity, and the reduction of adverse cardiovascular events. As part of the team, you will have frontline exposure to our portfolio vision, ... who want to do the same. In exchange, we offer the chance to be part of a truly global workplace, where passion and engagement are met with opportunities for… 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 ... and supply teams. The role will assist in development of actuarial analyses for Medicare Part D business, including but not limited to; special CMS programs,… 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** ... Manages the coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership skills that ensure successful … 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 ... PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ensure… more
- Walworth County (Elkhorn, WI)
- …This position is responsible for assisting Medicare beneficiaries with enrollment issues regarding Medicare Part D , Medicare Part C (Advantage ... it does not prescribe or restrict the tasks that may be assigned. Perform Medicare Part D drug assessments by entering consumer's drug information into the… 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …product development, operations, financing and revenue generating programs + Knowledge of Medicare Part D program, operations and industry trends ... 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
- Bristol Myers Squibb (Princeton, NJ)
- …reporting and analysis. **Responsibilities:** + Consolidate and maintain GTN projections for Commercial, Medicare Part D , and GPO contracted accounts + ... personal lives. Read more: careers.bms.com/working-with-us . **Summary:** The Commercial & Medicare Channel Lead will manage forecasting and analytics for the… more
- CVS Health (Northbrook, IL)
- …work closely with multiple internal departments such as Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementations ... - PBM Industry and plan design. - RxClaim adjudication or benefits knowledge. - Medicare Part D - PBM or claim adjudication knowledge. - Proficiency in IBM… 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 ... and pricing. The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies.… 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...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
- US Tech Solutions (May, OK)
- **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… more
- US Tech Solutions (AZ)
- …months contract** **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to ... by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines,… 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 ... necessity reviews for formulary exceptions and prior authorizations according to the Medicare Part D defined guidelines + Work with the Pharmacy Benefit… more
- US Tech Solutions (May, OK)
- …availability could be required. **Experience:** + Prior authorization experience preferred. + Medicare Part D experience required + Previous pharmacy ... of experience although 2-5 years is preferred. **Skills:** + Prior Authorization + Medicare Part D **Education:** + Bachelor's Degree Required, Pharm D … more
- Walgreens (Deerfield, IL)
- **Job Description:** **Job Summary:** Responsible for managing the finances for the Medicare Part D Pharmacy contracts with PBMs and insurance companies. ... role will help create relevant Power BI dashboards to help summarize Medicare Part D reimbursement performance. **Job Responsibilities:** + Develops complex… more
- Ascension Health (Nashville, TN)
- …adjudication, including troubleshooting and prior authorization processing. + Strong understanding of Medicare Part D and medication adherence quality ... support accurate, compliant documentation and communication. + Assist in tracking and improving Part D adherence metrics (eg, PDC for Diabetes, Hypertension, and… more
- Cambridge Health Alliance (Cambridge, MA)
- …PACE and HPO. * Lead internal and external audit preparation and response, including Medicare Part D and Enrollment Data Verification. * Develop and ... our participants. This role is responsible for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment, compliance, contract management, and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …(eg PBM) to assist in the development, communication and implementation of Commercial and Medicare Part D formulary and clinical program offerings. + ... to ensure that all Commercial (Pharmacy and Medical benefits) and Medicare Advantage Part D coverage determination requests are processed consistently,… more
- East Boston Neighborhood Health Center (Revere, MA)
- …annual MassHealth applications and Medicare Secondary Payers Surveys + Ensuring that all Medicare Part D YTD Explanation of Benefits are received and ... + Strong knowledge of MassHealth eligibility + Strong knowledge of the overall Medicare eligibility of Part A, B and D + Verifying all insurances prior to… more
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