- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Medicare Compliance works directly with the Vice President Medicare Compliance /National ... Program; and disseminating requirements to appropriate internal staff. The Director of Medicare Compliance is accountable to strengthen internal controls,… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Under direction of the Director of Medicare Compliance , the primary focus areas of this position include development ... + 5 or more years direct work experience in regulatory affairs and/or compliance in Medicare or Medicaid required + 5 or more years of managerial experience… more
- Prime Therapeutics (Boston, MA)
- …fuels our passion and drives every decision we make. **Job Posting Title** Medicare Health Plan Operations Specialist - Remote **Job Description** The Associate ... or Director in PBM Operations, Specialty Operations, Clinical Operations, Compliance , Clinical Review, or Supply Chain Shared Services Potential pay for this… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible ... leadership and oversight for the Quality & Control Assurance within CCA's Compliance department. This position designs, continually matures, promotes, & develops a… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director , Inpatient Utilization Management (UM), leads and manages all utilization management (UM) functions for all ... level of care to ensure achievement of business results while maintaining compliance with all contract requirements, state and federal regulatory requirements and… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Commonwealth Care Alliance (Boston, MA)
- …population and **avoid unnecessary ED visits 88% of the time** . The Sr. Medical Director , InstED is a key clinical leader and member of the instED management team, ... necessary amidst expanding operations. + As appropriate, partner with instED Sr. Director of Operations, especially on regulatory issues, such as annual reports to… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position Overview** **:** We areseekinga highly skilled and experienced Director of DevOps to lead our DevOps team and drive the implementation of ... proventrack recordof successfully implementing DevOps strategies in complex environments.The Director will have experience collaborating to produce high performing… more
- Fresenius Medical Center (Waltham, MA)
- **POSITION FEATURES:** This is a remote position with 25% travel **PURPOSE AND SCOPE:** Manages a field team of regulatory compliance employees and provides ... Pertinent regulations include, but are not limited to: + Federal Center for Medicare and Medicaid Services (CMS); End Stage Renal Disease (ESRD) Program regulations… more
- Commonwealth Care Alliance (Boston, MA)
- … (CHC) preferred + 5 or more years direct work experience inregulatory affairs and/or compliance in Medicare or Medicaid required + 5 or more years of managerial ... is Important to Us:** Under direction of the Sr. Director of Regulatory & External Audits, the primary focus...external regulatory agencies including but limited to Centers for Medicare & Medicaid Services (CMS), Mass Health, Departments of… more
- Prime Therapeutics (Boston, MA)
- …we make. **Job Posting Title** Physician Clinical Reviewer, MRx - Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and ... review process so as to reflect appropriate utilization and compliance with Prime's policies/procedures, as well as URAC and...+ On a requested basis, may function as Medical Director for select health plans or regions, assuming overall… more
- Bristol Myers Squibb (Boston, MA)
- …more: careers.bms.com/working-with-us . Reporting into the Medical Value Liaison Field Director , the Senior Medical Value Liaison (MVL)/Executive MVL is a ... product and disease state education to health care decision makers in compliance with all policies and procedures + Build strategic, long-term relations with… more
- Aveanna (Needham Heights, MA)
- …clinician will be responsible for managing and scheduling patient visits to ensure compliance with agency policies and applicable regulations and standards. + At the ... of the location and in collaboration with the clinical director . + Increasing autonomy in the role is encouraged...difference in the lives of our patients and families. Remote and hybrid work is limited to the United… more
- Philips (Cambridge, MA)
- …strive to maintain positive relationships with customers by driving the compliance of contractual obligations, identifying areas of improvement and program quality ... Management System (CMMS) support cases for field technicians + Support the compliance of the Philips Biomed/Clinical Engineering program which includes Centers for … more