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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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The primary role of the Population Health Management Pharmacist is to provide leadership and guidance for the plan’s various population health related goals such as Medicare Part D Star Ratings and medication related Healthcare Effectiveness Data and Information Set (HEDIS) measures to achieve continuous improvement and overall high quality metric scores.
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Compliance oversight for "Schedule A" request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA. Compliance oversight for "Schedule A" request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA.
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Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide.
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Medicare Part D - Submit Medicare Part D disclosure letters to client as per Benefit Timeline. Assist bSwift team with set-up of client web site as directed by Benefits Operations Manager.
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Knowledge and experience in Medicare Part D, Medicaid, and commercial payer policies, reimbursement process, health policy, areas of coverage and payment. Arvinas, as part of its overall business strategy, selectively assesses opportunities for potential collaboration, license, marketing and royalty arrangements, and similar transactions, to advance and accelerate the development and enhance the commercial potential of its product candidates.
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Call Center Management and Insurance and reimbursement experience for Medicare Part D, Commercial and other Government Insured patients a plus. Monitor and enforce standards and regulations during quarterly and annual program audits (e.g. Safety, R&D, 501c3 Financial, Corporate Compliance, and Inventory.
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Medicare Part D or pharmacy pricing experience preferred. The colleague’s primary focus will be on Part D product strategy and financial analysis. This role is focused on the financial analysis, projection and strategy development of manufacturer rebates within Part D plans.
$63,300 - $136,500 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Managed Care experience and knowledge Medicare Part D experience and knowledge Experience with Microsoft Word, Excel, PowerPoint, Access, and Outlook Skills Strong organizational and planning skills Effective verbal and written communication skills Fluent in all typical office software programs (Word, Excel, and PowerPoint.
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Supports RFI and RFP submissions as well as pre-sales opportunities for Medicare Part D and Managed Medicaid clients. Oversees and supports all Medicaid & Medicare Part D operational tasks in compliance with applicable federal, state and local laws, rules, regulations and internal policies and procedures.
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Efforts include solving client Medicare Part D issues relative to their delegated services, reporting, and will interface with the Clinical Account Executive for clinical issues. Assists the Medicare Part D Program Manager with Contract and Scope Definition Document maintenanceAttends Client Facing Value Summaries at least twice annually, providing overviews of projects, compliance, and annual re-implementation effortsWhat our team expects from you.
$63,773 - $83,750 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Understands the complexities of a health system in addition to Medicare/SNP/LIS and Part D. Able to work in tandem with internal partners such as: Marketing, Compliance, Regional Sales Directors, National Sales Directors , Medicare VPs, Stars team, Medicaid team and various other departments as needed.
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This specific role will focus significantly on Medicare Part D. You will use and develop a strong knowledge of specialty pharmaceuticals, disease management and therapeutics. It will be necessary to create clinical content for Medicare Part B, including standard and client requested programs with the ability to be consultative to product owners, Trade, account management and clients.
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Make your mark for patientsWe are looking for a Commercial Operations Analyst – Rebates to join our Contracts & Pricing team located in Atlanta, GA About the roleThe Commercial Operations Analyst will be responsible for the timely and accurate processing of Commercial, Trade and Medicare Part D rebates in compliance with contract terms.
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Medicare Part D Experience. Medicare Part D Experience. Knowledge of prescription drug names, therapeutic classes and claims processing. Minimum 2 years of experience in Pharmacy Retail, PBM, Hospital, Managed Care.
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