- Humana (Lansing, MI)
- …on problems of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual...management and clinical programming + Represents Humana at all Pharmacy Medicaid meetings including those with the… more
- Banner Health (AZ)
- …accordance with policies and procedures under the immediate supervision of a pharmacy technician supervisor, a pharmacist, and/or medical director . CORE ... the formulary, member cost-sharing, and regulatory requirements, both AHCCCS and Medicare . Assures that pharmacy claims are adjudicating correctly. Maintains… more
- Prime Therapeutics (Jefferson City, MO)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director , Pharm Trade Relations leads a team of ... every decision we make. **Job Posting Title** Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr...the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies,… more
- WMCHealth (Valhalla, NY)
- …Compliance & Quality Assurance: + Ensure all activities are compliant with HIPAA, Medicare / Medicaid billing regulations, and the 340B Drug Pricing Program + ... + Preferred: + 340B University Additional Information: + Reports to:Associate Director - Pharmacy Operations + Schedule:Full-time, with potential weekend… more
- Abbott (Washington, DC)
- …Payment Systems, o Ambulatory Surgery Center payment systems, o Physician payments, o Pharmacy payments/processes o Medicare quality systems, o the Center for ... in the Government Affairs function. As the Government Affairs Director for Corporate Reimbursement, you will develop, lead and...policy **Preferred Qualifications** * Experience in the Centers for Medicare and Medicaid Services (CMS) or Health… more
- CVS Health (Hartford, CT)
- …"base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. * ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...Two (2) + years of experience in managed care ( Medicare and/or Medicaid ) MD or DO; Board… more
- University of Colorado (Aurora, CO)
- …for reporting to leadership and the board. + Coordinates and submits annual Medicare and Medicaid cost reports, quarterly audit and reporting requirements, and ... management. + Healthcare Industry Knowledge: Understanding of payment reform, Medicare , Medicaid , private insurance regulations, and healthcare operations.… more
- Molina Healthcare (Layton, UT)
- …policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management, Group/IPA ... medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. + Reviews quality… more
- CVS Health (Springfield, IL)
- …(PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare / Medicaid ) programs and individual client requested coverage determinations ... Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM… more
- Prime Therapeutics (Helena, MT)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to ... management experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid , Exchange, Commercial, Employer Group) Every employee must… more
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