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PBMs administer prescription drug plans for more than 275 million Americans who have health insurance from a variety of sponsors, including commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, managed Medicaid plans, and others.
Full-timeExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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Bachelors degree, advanced degree (MA or JD) preferred. Collaborating with Association policy, research, legal and public affairs leaders to ensure that initiatives align with member and Association objectives.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Overseeing all departmental activity from managing internal activities such as bill tracking and document management to external state lobbying and intergovernmental activities. Leading the PCMA State Affairs team in planning and executing a successful state government relations strategy.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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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.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Ensure Account Manager is performing all tasks as outlined in the MMA Assistant Account Manager or Account Manager Job Description. Assist bSwift team with set-up of client web site as directed by Benefits Operations Manager.
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Assist bSwift team with completion of the bSwift requirements document for any assigned clients that are engaging bSwift as their ben admin and online enrollment technology. Capable of Gathering and Analyzing ICAF, Milliman, Aggregate and DMW reports.
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Priority areas include Medicare Advantage, Medicare Part D, dual-eligible beneficiaries, Medicaid, primary care, home health care, homelessness, health equity, social determinants of health, among others.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Negotiate pharmacy network reimbursement ethically in support of Navitus mission to meet or exceed clients and Navitus needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Retail, Specialty, and Mail Order Networks.
Full-timeRemoteExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Coordinates the arrangements for the Medicare Part D enrollment each fall. Meets with SHIIP chair to determine scheduling, supplies, publicity, and extra volunteers that assist with Medicare enrollments.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Function as team member of the Client Services team to ensure superior service to all MMA Clients. Coordinate and/or Deliver Wellness Presentations so that client understands full scope of MMA vendor capabilities.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Understanding of Self-funding, Stoploss, Pharmacy Benefit Management, ERISA guidelines, Affordable Care Act, Section 125, HIPAA and PHI. Oversees annual reporting and filings, ensures accuracy of data and meets appropriate deadlines for 5500 / SAR, Creditable Coverage and Medicare Part D CMS disclosures, CMS demand letters, Healthcare Exchange Appeals, Covered California Appeals, 1095-C, PCORI, Form 720 and Non-Discrimination Testing.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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8+ years of experience which includes experience in the following: Management consulting in healthcare industry, Customer experience transformation, MAPD and Rx/Part D customer service operations management and/or experience improvement, Project management, stakeholder management, Client service completing requirements gathering, design and implementation.
$141,930 - $173,470 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.
$74,579.76 - $85,766.73 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Provide information to HCP on how the products are covered under the benefit design (Commercial, Medicare Part D, Medicaid) Experience with commercial payers, Medicare plans and state Medicaid in geographic region.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Knowledge of PPO, HMO, EPO, diagnostic codes, CPT codes, and Medicare/Medicare part D plans. Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines ; or any combination of education and experience which would provide an equivalent background.
ExpandApply NowActive JobUpdated 2 days ago
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