- Guidehouse (Boston, MA)
- …financial, operational, and technical-are validated for safety, reliability, and compliance across DPH hospitals, DMH facilities, SOPS, and community-based services. ... codes). + **Build Quality Audit (BQA)** : Confirm configuration accuracy and compliance with Oracle Health standards. + **System Testing** : Validate end-to-end… more
- CenterWell (Orlando, FL)
- …pharmacists. This role is a specialized function rooted in compliance , education, and conversion. Consumer Engagement, Consultative Pharmacy Technician are ... + Document member interactions with thoroughness and clarity in accordance with compliance standards. + Adhere to scripting protocols while maintaining a natural,… more
- University of Rochester (Rochester, NY)
- …is responsible for the oversight, operational integrity, regulatory/legal compliance and financial performance for all Ambulatory/Outpatient pharmacy programs ... procedures across the UR Medicine outpatient pharmacy system to ensure compliance with State and Federal Regulations, accreditation standards and third-party payer… more
- CenterWell (Santa Fe, NM)
- …to obtain details necessary for prioritization (eg member experience improvements, compliance impacts, client goals, etc.) + Create project intake and prioritization ... on continuously improving consumer experiences **Preferred Qualifications** + managing complex PBM projects **Additional Information** As part of our hiring process… more
- Humana (Indianapolis, IN)
- …monitors, and assists with the management of psychopharmacology pharmacy benefits manager ( PBM ) activities, including the establishment of prior authorization, ... represents Humana at public forums and engagement opportunities + Maintains compliance with BH-related Contract requirements and attends oversight committee meetings… more
- UPMC (Pittsburgh, PA)
- …(NCD) or Local Coverage Determination (LCD). + Evaluate referrals from Pharmacy Benefit Manager ( PBM ) by analyzing medical and pharmacy claims and associated ... training new staff and auditing peers. Collects program data to monitor/ensure compliance requirements and establishes and revises better best practice within the… more
- Tetrad Digital Integrity LLC (Washington, DC)
- …payer systems including: claims processing, enrollment and eligibility platforms, Pharmacy Benefit Manager ( PBM ) integrations, CRM and call center platforms and ... Participate in governance forums - Architectural Review Board (ARB), security and compliance reviews and Change Advisory Board (CAB) + Define and document… more
- CVS Health (St. Paul, MN)
- …savings and margin growth. + Provides strategic counsel to the General Manager on pharmaceutical market dynamics, including emerging therapies, pricing trends, and ... + Proven success leading strategic initiatives in healthcare, managed care, or PBM settings. + Deep knowledge of pharmaceutical market trends, pricing strategies,… more