Top 2445 Claims Program Manager Jobs

Pharmacy Program Manager (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $106,632 - $211,783 a year
- Full-time
- Master's degree
- Analysis skills
- Bachelor's degree
- 401(k)
Quick Apply
Program Manager/Training Lead
Contact Government Services, LLC —Remote
- $180,000 - $200,000 a year
- Full-time
- 5 years
- Mid-level
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Grants Program Manager
Office of the Chief Financial Officer (OCFO) —Washington, DC
- $92,664 - $137,565 a year
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Olympic Sports & Spine —Federal Way, WA
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- Mid-level
- Master's degree
- Bachelor's degree
- AD&D insurance
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Safety Manager - Bilingual
ROOF TOPPERS INC —Vancouver, WA
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- Full-time
- Microsoft PowerPoint
- Microsoft Word
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Behavioral Health Program Director
Center Point, Inc —San Rafael, CA
- $80,000 - $90,000 a year
- Full-time
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- Writing skills
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Senior Director of Safety
Magnum Electric Inc —West Fargo, ND
- Full-time
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- In-person
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Olympic Sports & Spine —Puyallup, WA
- $27.00 - $38.15 an hour
- Full-time
- Mid-level
- Master's degree
- Bachelor's degree
- AD&D insurance
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Clinical Director (PSP)
State of Kansas - Larned State Hospital —Pawnee County, KS
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- Background check
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Director of Cyber Risk & Assurance
Wis Phys Svc Ins Corp —Madison, WI
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Vice President of Nutrition Services
Heritage Community Initiatives —Pittsburgh, PA
- Email
- Sales
- ServSafe
- Customer service
- Paid holidays
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AmeriCorps Pathway Program Coordinator
Milwaukee Area Health Education Center —Milwaukee, WI
- $1,858.33 a month
- Temporary
- Hybrid work
- Background check
- Computer skills
- Reliable transportation
- Health insurance
- Dental insurance
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Technical Program Manager
LTM —Bellevue, WA
- $80,000 - $90,000 a year
- In-person
- Senior level
- Paid parental leave
- Paid holidays
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Environmental Health and Safety Supervisor
Lactalis Heritage Dairy Inc —Walton, NY
- $60,000 - $70,000 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Tuition reimbursement
- Paid time off
Quick Apply
Director of Pharmacy (SCR)
State of Kansas - SC Regional Mental Health Hosp —Sedgwick County, KS
- $145,000 a year
- Weekends as needed
- Background check
- Psychiatry
- Bachelor of Science
- Paid holidays
- Health insurance
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Director of Human Resources
St Coletta of Wisconsin Inc —Jefferson, WI
- Experience working with individuals with disabilities
- 5 years
- Master's degree
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Staff Counsel - Liability Claims
Forward Air —Coppell, TX
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Data analysis skills
EHS Manager (Days)
Sabre Industries —Hicksville, OH
- From $84,150 a year
- Weekends as needed
- Bachelor of Science
- 3 years
- Bachelor's degree
- Paid holidays
- Disability insurance
2d
Safety Director
Premise INC —Minneapolis, MN
- $120,000 - $140,000 a year
- Full-time
- CPR Certification
- Construction site
- Office
Quick Apply
2d
SLS Program Manager - Supported Living Services
Thrive Support Services, Inc. —Martinez, CA
- $73,000 - $88,000 a year
- Urgently hiring
- CPR Certification
- Master of Social Work
- Nursing
- Profit sharing
- Mileage reimbursement
Quick Apply

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Pharmacy Program Manager (Hybrid)

CareFirst BlueCross BlueShield -
Baltimore, MD

Quick Apply

Job Details

Full-time
$106,632 - $211,783 a year

Benefits

401(k)

Qualifications

Vendor relationship building
Contracts
Process improvement planning
Research findings presentation

Full Job Description

Resp & Qualifications

PURPOSE:
Manages end-to-end oversight of Pharmacy initiatives. Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive pharmacy strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance.

ESSENTIAL FUNCTIONS:

Manages complex pharmacy program(s) or strategic initiatives that span organizational boundaries and have a significant legal and/or financial impact to CareFirst Business. Identifies process improvement opportunities and takes action to implement enhancements to maximize outcomes and growth.

Coordinates with internal and external stakeholders to launch, maintain, and enhance complex pharmacy program(s). Provides direction and motivation to project teams in a matrixed environment. Drives outcomes by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors. Develops and provides formal written and verbal presentations or other communication materials for appropriate management and various committees to support Pharmacy programs and initiatives. Leads innovative solutions to meet pharmacy and corporate goals.

Monitors PBM compliance, financial performance and reconciliations while identifying trends to support strategic decision-making.

Oversees a key initiative focused on the timely and accurate calculation of payments and reconciliations for pharmacy rebates, network discounts and medicate rebates for ASO/CFA accounts.

Measures, evaluates and reports on Pharmacy program(s) performance related to ROI, customer satisfaction, and other organizational metrics. Effectively forecasts and manages people, process and technology related resources to ensure successful achievement of corporate goals.

Guides stakeholders and leadership through key decisions and communicates and coordinates activities internally and across network of partners.

SUPERVISORY RESPONSIBILTY:

Leads a team utilizing a matrix management system.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Management or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 8 years project management or program management experience.

Licenses/Certifications:
Certified Project Management Professional (PMP)-PMI Preferred

Preferred Qualifications:

Master's Degree
Project Management Professional Certification (PMP)

Knowledge, Skills and Abilities (KSAs)

Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.
Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.
Ability to translate business needs as it relates to technology, systems, and vendor platforms.
Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
Knowledge and discipline of Process Improvement.
Use of Microsoft Applications.
Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts.

Travel Requirements
Estimate Amount: Limited

Salary Range: $106,632 - $211,783

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

#LI-LJ1

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