- Prime Therapeutics (Harrisburg, PA)
- …related partner/customer relationships including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director, Pharm ... + Direct the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as… more
- WellSpan Health (Lebanon, PA)
- …members of the health care team. Primary responsibilities include identification of Medicare patients appropriate for Annual Wellness Visits (AWV) and execution of ... knowledge, skills, and experience. **Duties and Responsibilities** **Essential Functions:** + Review office schedules and identify patients appropriate and due for … more
- Prime Therapeutics (Harrisburg, PA)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Evolent (Harrisburg, PA)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Harrisburg, PA)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Evolent (Harrisburg, PA)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Harrisburg, PA)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Evolent (Harrisburg, PA)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Organon & Co. (Plymouth Meeting, PA)
- …state government pricing programs, including Medicaid Drug Rebate Program (MDRP), 340B, Medicare Part B/D, and the Veterans Affairs (VA)/Department of Defense (DOD) ... with GP AD & third-party government pricing vendor to implement, execute, review and approve price reporting. + Partner with third-party government pricing vendor… more
- Penn Medicine (Lancaster, PA)
- …to support changing patient care needs. Participates in the development and review of patient care standards, protocols and guidelines. + Monitors utilization of ... Functions as a patient advocate. + Participates in peer review activities identifying learning needs of practice related issues...+ A health care provider in good standing with Medicare , Medicaid and other federal and state health insurance… more