- Centene Corporation (Queens, NY)
- …Oversee Medicare -specific VBP contracts, focusing on implementation, performance management , and education of provider partners regarding CMS -aligned models, ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- The Cigna Group (Bloomfield, CT)
- …position will provide external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space. This actuarial ... to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal leadership within… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... + AHIP certified + Computer/technology literacy + Compliant with CMS and CPHL policies. + Follow CPHL, CMS...CPHL sites located throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare … more
- Molina Healthcare (Scottsdale, AZ)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- Baylor Scott & White Health (Temple, TX)
- …medication adherence, etc.). Monitor regulatory updates and ensure compliance with CMS Star Ratings requirements. * Clinical Metrics Management : Analyze ... Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well....healthcare quality, with at least 3 years focused on Medicare Advantage Stars. * Strong knowledge of CMS… more
- Prime Therapeutics (Harrisburg, PA)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...that have impacts on members, providers, Part D plans, CMS , and the company. Requires a working knowledge of… more
- US Tech Solutions (May, OK)
- …applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance. + Additionally, the role includes participating ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits.… more
- CVS Health (Tallahassee, FL)
- …risks and issues is essential. Additional responsibilities include: - Supporting the annual CMS bid filing for the Group Medicare business. - Reviewing annual ... BID cycle and the review of the yearly CMS required member materials. This role will interact daily...SME. **Required Qualifications** 2+ Years working in the MPDT system 4+ Years Employer Group Medicare industry… more
- Wider Circle (Los Angeles, CA)
- …Scope of Appointment, the presentation of the product, sales conversion and relationship management of a Medicare beneficiary * Daily tasks include completing a ... a fast-growing boutique insurance agency focused on helping people understand their Medicare Benefits. We work with underserved populations to help them navigate … more
- Providence (WA)
- …clinical quality (Stars HEDIS) measures, CAHPS, HOS + Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, ... **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager -...Expert (SME) who is experienced at using Stars data, CMS Star Rating Technical Notes and HPMS memos to… more