- Excellus BlueCross BlueShield (Rochester, NY)
- …we encourage you to apply! Job Description: This pharmacist clinician is a program manager , who is responsible for all Medicare Part D formulary creation and ... and sales to maximize savings, ensure quality, and minimize member disruption, while incorporating all CMS Part D guidance...years' experience in a managed care setting. Experience in Medicare Part D is strongly… more
- CVS Health (Albany, NY)
- …compassionate. And we do it all with heart, each and every day. As a Senior Manager within the Aetna Medicare Pharmacy team, you will play a critical role in ... processes, including Medispan review. + Support and assist with Medicare Part D guidance and information in member...state of residence + 5+ years of relevant work experience in product management, strategy, or a related field… more
- Molina Healthcare (Syracuse, NY)
- …+ Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed. + Participates in regular ... member to ensure needs are met and member is having a positive plan experience ....manager . Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate's or Bachelor's Degree in Social… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Preferred: + Bilingual with English as a primary language + 3 plus years of, Medicare or Sales experience . + Valid Driver's License and access to personal ... performing all required tasks assigned by the Sales Field Manager . Incumbent will be responsible for educating and enrolling...Health & Accident License Preferred: 3 plus years of, Medicare or Sales experience SCOPE INFORMATION #… more
- CVS Health (Albany, NY)
- …multiple projects and priorities at the time and committed to improving member experience and program performance. **Position Duties & Responsibilities** + ... Sales teams, Customer Service, Operations, Claims, Case Management, etc. + Partners with Member Experience team, marketing and sales in deploying local member… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for ... Quality Assurance (NCQA) accreditation standards, as appropriate to the member 's case assignment. Uses a systematic approach to identify members meeting program… more
- Humana (Albany, NY)
- …takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, ... caring community and help us put health first** The Manager , Fraud and Waste conducts investigations of allegations of...Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals. +… more
- Humana (Albany, NY)
- …assessments and/or evaluations while maintaining compliance with CMS regulations. The Care Manager Telephonic Nurse must also assess for member physical, ... community and help us put health first** The Care Manager , Telephonic Nurse utilizes clinical nursing skills to support...patient education for adult acute care + Managed care experience + Previous Medicare /Medicaid experience … more
- CenterWell (Albany, NY)
- …part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... improvements in unbilled rates, revenue cycle performance, and compliance. The Manager leads a team of Pre-Bill Specialists, partners with senior leadership,… more
- Ellis Medicine (Schenectady, NY)
- SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This position works with the ... efficient quality care and achievement of desired treatment outcomes. The Case Manager confirms admission and continued stay are medically necessary and ensures the… more
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