- Prime Therapeutics (Frankfort, KY)
- …department. Works to ensure established rules, policies, and procedures are implemented so that Medicare Part D operations are successful, efficient, ... drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs...Provides the technical and leadership skills that ensure successful Part D pharmacy operations and… more
- CVS Health (Frankfort, KY)
- …years of experience in Medicare Advantage actuarial pricing, bid development, and CMS Part C/ D operations . + 5+ years' experience working with CMS ... on enhancing pricing accuracy, optimizing bid strategies, and supporting Medicare operations through advanced analytics and actuarial...the development and execution of actuarial analytics strategies for Medicare Advantage and Part D … more
- Humana (Louisville, KY)
- …moderate to substantial. The Risk Adjustment Organization seeks a Program Delivery Lead for Part D Risk Adjustment. This role will partner with leaders to ... improve existing programs and develop next-generation initiatives to ensure Part D risk score documentation is timely, complete, and accurate, while promoting… more
- Molina Healthcare (Lexington, KY)
- …The Operational/Regulatory Oversight Analyst works with health plans and operations departments to assess, oversee, and recommend business practices to ... Analyst develops and performs audits and oversight functions involving business-critical operations and vendor outsourcing arrangements for the company. The Analyst… more
- Molina Healthcare (Owensboro, KY)
- …data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations , and clinical teams-to ensure accurate and consistent data interpretation. ... + Participate in internal simulations and mock audits as part of proactive audit readiness. + Contribute to the...of experience in data analytics, business intelligence, or healthcare operations + Foundational proficiency in SQL and exposure to… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us...as we prepare for the launch of Fully Integrated D -SNP (FIDE) plan in 2026. This individual will focus ... put health first** The MBA Intern - Illinois Medicaid ( Part -time, Fall 2025) will contribute as a team member...on driving scalable, innovative initiatives with local market operations , clinical, and finance leaders that improve members health… more
- BrightSpring Health Services (Louisville, KY)
- …MOR, Sales, Key Strategic Operational changes, etc. + Assist with Member reconciliation, Part D Recon, LIS tracking, Rebate tracking, Claim subrogation, and ... Medical Services company, Population Health Management services company, and a Medicare Advantage Institutional Special Needs Plan (I-SNP).Under the direction of the… more
- WelbeHealth (Frankfort, KY)
- …of capitation payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D ) along with PACE rates and regulatory ... all aspects of our revenue recognition model under ASC 606, revenue operations , control environment, and all required state and federal reporting requirements.… more
- Prime Therapeutics (Frankfort, KY)
- …variety of constituents **Preferred Qualifications** + Integrated health system or health plan experience + Medicare Part D and B experience + Call center or ... responsible for the strategic leadership and operational direction of Member Operations solutions related to interaction with Prime Therapeutics clients to… more