- 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 (Pierre, SD)
- …fuels our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs **Job Description** Manages 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 (Atlanta, GA)
- …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
- Centene Corporation (Jefferson City, MO)
- …+ 3+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. + Some ... forms, reports, and data. + Tracks all sales issues referred to the Medicare Compliance Department up to and including resolution. + Performs special projects as… more
- Centene Corporation (Raleigh, NC)
- …and SMAC regulatory filings. + Manages Duals (and Medicare with D -DSNP specific or separate) compliance reporting responsibilities and respond to inquiries ... working knowledge of laws and/or regulations in area of compliance , in particular Medicare , D -SNP,...other job-related factors permitted by law, including full-time or part -time status. Total compensation may also include additional forms… more
- Independent Health (Buffalo, NY)
- …and presentation skills with an ability to design and develop adult learning programs OR Medicare Advantage or Part D experience required. + Experience in ... sales plan. + Develop, deliver, test, and monitor effective Medicare products, sales, and compliance training programs...matter expert within product team in the review of Medicare Advantage and Part D … 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
- 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- …care. Ability to prioritize caseload. Knowledge of community resources. Knowledge of Medi-Cal and Medicare regulations. Ability to work as a part of a diverse ... Care Management Specialist II ( D -SNP) Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition… more
- Prime Therapeutics (Washington, DC)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal is… more
- Guthrie (Cortland, NY)
- …Provides leadership to the organization relative to the Clinical Regulatory Compliance program which assures the implementation and oversight of clinical ... requirements developed by the Center for Medicare and Medicaid (CMS), the Department of Health (DOH),...Commission (TJC). The primary purpose of the Clinical Regulatory Compliance Program is to ensure that the policies and… more
- Elara Caring (Dallas, TX)
- …Health, and Personal Care Services (PCS) agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations and billing rules. Areas of ... Time, in the Right Place. **Job Description:** The Billing Compliance Auditor performs comprehensive audits within the Skilled Home...health journey, we care. Each team member has a part to play in this mission. This means you… 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 ... execution of core plan functions in line with CMS Part C & D regulations + Manage...(TPA) Regulatory and Compliance Oversight + Ensure compliance with CMS Medicare Advantage regulations, including… 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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … 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
- Trinity Health (Columbus, OH)
- …experience. A thorough understanding of NCQA and HEDIS is required. Knowledge of Medicare Stars-including CAHPS, HOS, Part D , and operational measures-is ... responsible for report/dashboard creations, data verification and, QA in compliance with the Plan requirements and CMS guidelines. **What...thorough knowledge of NCQA and HEDIS. + **_Knowledge of Medicare Stars (CAHPS, HOS, Part 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. ... This role will help create relevant Power BI dashboards to help summarize Medicare Part D reimbursement performance. **Job Responsibilities:** + Develops… more