- 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
- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Director - Pharmacy Acute Care Services and Revenue Cycle **Cost Center:** ... (United States of America) **Job Description:** **JOB SUMMARY** The Director - Pharmacy Acute Care Services and...excluded from participation in any federally funded program, including Medicare and Medicaid . This is a condition… 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
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Senior Director , Pharmacy **Cost Center:** 301641296 Pharmacy -Admin **Scheduled Weekly ... 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
- SSM Health (Oklahoma City, OK)
- …Enforcement Administration, State Board of Pharmacy , Joint Commission, Centers for Medicare and Medicaid , etc..) + Develops and enforces policies and ... services, 13 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company and an accountable care… 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
- BrightSpring Health Services (Arlington, TX)
- …on outstanding claims + Individual with an understanding of Insurance and Medicaid formularies and processes including the prior authorization processes + Makes ... needed to obtain approvals + Works with Client Billing Service Offices, Pharmacy Directors, customers and prescription drug plans to effectively communicate and… more
- Centene Corporation (Dover, DE)
- …for both the Long-Term Services and Supports (LTSS) and Medicare - Medicaid Duals populations. Additionally, the Medical Director will collaborate with ... and Care Coordination Director to manage and optimize LTSS and Medicare - Medicaid Duals program operations, focusing on improving quality metrics and member… more
- WMCHealth (Valhalla, NY)
- …Compliance & Quality Assurance: + Ensure all activities are compliant with HIPAA, Medicare / Medicaid billing regulations, and the 340B Drug Pricing Program + ... + 340B University Additional Information: + Reports to: Associate Director - Pharmacy Operations + Schedule: Full-time,...Assurance: + Ensure all activities are compliant with HIPAA, Medicare / Medicaid billing regulations, and the 340B Drug… 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
- 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
- Arvinas (New Haven, CT)
- …relationship and engagement with targeted regional and national payers including Commercial, Medicare and Medicaid payers. Support non targeted payers as needed. ... important member of the Arvinas Market Access Team, the ** Director , Payer Accounts** will be a key contributor to...strong preference for knowledge of national and regional payers, Medicare Part D, and Medicaid . + National… 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
- Molina Healthcare (Racine, 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
- CVS Health (Springfield, 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
- Walgreens (Deerfield, IL)
- …Systems, various other providers, etc), the various lines of business (Commerical, Medicare , Medicaid , etc) and the various healthcare services provided in ... business. Regional accounts, managed markets marketing, sales and district pharmacy constituents. + Collaborates with internal manufacturer or pharma relations… more
- AbbVie (Irvine, CA)
- …and distribution channels including Commercial health plans, PBMs, Medicare , Medicaid , VA/DoD, Employer, Health System, Pharmacy , Wholesalers and GPO's ... (both Pharmacy and Medical reimbursement). Includes awareness of commercial, Medicare , Medicaid , other government, and specialty segments. + Experience with… more
- The Cigna Group (St. Louis, MO)
- …Director of Regulated Markets is responsible for Coverage Review and Determinations for Medicare Part B and Part D, Medicaid , Marketplace or Healthcare Reform ... **Job Description: Director for Regulated Markets - CDAG/ODAG** **Excited to...of technical requirements to ensure ongoing compliance, Center for Medicare and Medicaid (CMS) Audit support and… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …dynamics. The individual will be required to have in-depth knowledge of payer policy, Medicare , Medicaid and the Oncology Care Model. This individual is ad ... areas centered around rare diseases and immune disorders. **Summary:** The Associate Director , Oncology Value & Market Dynamics Training Manager is responsible for… more
- BrightSpring Health Services (Gainesville, FL)
- …ensure compliance with Company policies and procedures, state licensure and regulations, Medicaid , and Medicare standards, as well as state reimbursement ... Our Company ResCare Community Living Overview The Assistant Director of Nursing is responsible for assisting the Director of Nursing with the daily performance… more