• Senior Compliance Professional;…

    Humana (Providence, RI)
    …of variable factors. The focus of this role is Medicare Pharmacy and Part D . The Senior Compliance Professional will analyze business requirements, ... **Become a part of our caring community and help us...Compliance or Health Plan Operations + Familiarity with Medicare pharmacy laws or regulations **Additional Information** Interview Format… more
    Humana (07/03/25)
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  • Clinical Pharmacist Advisor

    US Tech Solutions (May, OK)
    …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
    US Tech Solutions (04/18/25)
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  • Pharmacist

    US Tech Solutions (AZ)
    …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
    US Tech Solutions (04/18/25)
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  • Actuary - Medicare Part D

    The Cigna Group (Bloomfield, CT)
    …is designed to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal ... role will assist in development of actuarial analyses for Medicare Part D business, including...Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting + Financial Reconciliation Modeling + Trend… more
    The Cigna Group (07/10/25)
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  • Senior Actuary - Medicare Part

    CVS Health (Hartford, CT)
    …and Aetna's exciting and growing government services pharmacy business. The primary focus is the Medicare Part D product strategy and pricing of MAPD, SNP ... and PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ensure… more
    CVS Health (06/22/25)
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  • AVP, Actuary - Medicare Part

    CVS Health (Hartford, CT)
    …do it all with heart, each and every day. Position Summary: The AVP, Actuary - Medicare Part D is responsible for analyzing and forecasting the financial ... internal and external cross-functional business issues. Preferred Qualifications: + Pharmacy and Medicare Part D experience strongly preferred Education: +… more
    CVS Health (06/27/25)
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  • Senior Compliance Analyst, Duals ( D

    Centene Corporation (Raleigh, NC)
    …and SMAC regulatory filings. + Manages Duals (and Medicare with D -DSNP specific or separate) compliance reporting responsibilities and respond to inquiries ... working knowledge of laws and/or regulations in area of compliance , in particular Medicare , D -SNP,...other job-related factors permitted by law, including full-time or part -time status. Total compensation may also include additional forms… more
    Centene Corporation (06/07/25)
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  • Medicare Sales Compliance Specialist

    Centene Corporation (Jefferson City, MO)
    …+ 3+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. + Some ... forms, reports, and data. + Tracks all sales issues referred to the Medicare Compliance Department up to and including resolution. + Performs special projects as… more
    Centene Corporation (05/30/25)
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  • Director, Quality Improvement…

    Trinity Health (Gaithersburg, MD)
    … with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of ... time **Shift:** Day Shift **Description:** **Director, Quality, Improvement and Compliance ** **Location:** Trinity Health PACE of Montgomery County, Gaithersburg, MD… more
    Trinity Health (07/10/25)
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  • Lead Director, Medicare Actuarial Analytics…

    CVS Health (Lansing, MI)
    …Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance ... The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
    CVS Health (07/01/25)
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