- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pricing, Medicaid, Medicare , and other market access matters and issues.- Monitor current developments in several key legal areas and provides Senior Management ... but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and… more
- Molina Healthcare (NM)
- …coaching to technicians and representatives under direction of the supervisor. + Reviews Medicare pharmacy technician work for accuracy to ensure compliance with ... Molina Pharmacy Services/Management staff work to ensure that Molina Medicare members have access to all medically necessary prescription drugs and those… more
- Molina Healthcare (Long Beach, CA)
- …development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements… more
- The Cigna Group (Bloomfield, CT)
- …Advisors and Advisors responsible for the development and management of the Medicare Prescription Payment Plan (M3P) product. This individual will provide leadership ... in managing client facing products, broad-based knowledge of Regulated Markets/ Pharmacy Benefit Manager (PBM) operations, experience leading people, a strategic… more
- Walgreens (Washington, DC)
- …and monitor the effectiveness of these communications. + Coordinate Internal Communication: Ensure timely and accurate communication of relevant issues to ... experience. + Healthcare related committee experience. + Knowledge of retail or pharmacy issues, Medicaid, Medicare and health care. + Experience working… more
- LA Care Health Plan (Los Angeles, CA)
- …and guiding projects relating to quality excellence in Centers for Medicare and Medicaid Services (CMS) Five-Star Rating System and Marketplace Exchange ... project progress and outcomes. Manage vendor contracts. Facilitates collaboration with internal and external stakeholders to ensure the full integration of… more
- Cedars-Sinai (Beverly Hills, CA)
- …serve as the primary professional staff member in the Department of Pharmacy responsible for the clinical and medication use policies within Cedars-Sinai Medical ... usage and cost trends and work with the appropriate internal parties to develop clinical initiatives focusing on methods...with applicable state and federal regulations, including CMS and/or Medicare Part D and Medi-Cal, as well as accreditation… more
- VNS Health (Manhattan, NY)
- …staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health product lines. * Ensure Compliance: Stay ... Your expertise will help us navigate the ever-evolving healthcare landscape. * Monitor and Audit: Collaborate with subcontractors, ensuring they meet our high… more
- CenterWell (Dallas, TX)
- …medical interpretation, reviews, and decisions as required for plan administration. + Monitor medical performance and provide guidance to ensure that the quality of ... all departments providing medical guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet… more
- CenterWell (Tallahassee, FL)
- …ICD-10-CM, CPT, & HCPCS codes that are submitted to the Centers for Medicare and Medicaid Services (CMS), other payers, and over government agencies. In addition, ... the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May… more
