- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Care Manger is responsible for facilitating care for members and ... health care disparities, social determinants of health, and any barriers to care . The Clinical Care Manger will engage members in appropriate plans of … more
- Humana (Boston, MA)
- …such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or ... conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements...MD or DO degree + 5+ years of direct clinical patient care experience post residency or… more
- Humana (Boston, MA)
- …such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,...of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise… more
- Humana (Boston, MA)
- …(such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand… more
- Humana (Boston, MA)
- …such as inpatient rehabilitation. **Preferred Qualifications:** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid ... of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or Medicaid...MD or DO degree + 5+ years of direct clinical patient care experience post residency or… more
- Humana (Boston, MA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... Utilization management experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance. +… more
- Evolent Health (Boston, MA)
- …for Evolent Primary Care and sub-plans for each business segment (MSSP, Medicare Advantage , and Commercial payer partnerships) + Sets clear goals and ... ECP launched as an internal start-up in 2020 with a wholly owned Medicare Shared Savings Program ("MSSP") Accountable Care Organization ("ACO") spanning four… more
- CenterWell (Boston, MA)
- …+ Bachelor's degree + Telephonic sales experience + Understanding of value-based primary care and/or Medicare Advantage + Bilingual in English/Spanish with ... service, effectively describes services offered and sell prospective patients on the clinical care model, documents and modifies contact notes across multiple… more
- Humana (Boston, MA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... in region of assignment + 5+ years of direct clinical patient care experience post residency or...+ Experience in an inpatient environment and/or related to care of a Medicare type population (disabled… more
- Humana (Boston, MA)
- …relevant Master's level degree + Management consulting background + Experience with Medicare Advantage **Additional Information** + Flexibility with remote work ... cross-functional partners across product, marketing, sales, member experience and clinical to drive the evolution of data driven insights...serve to achieve their best health - delivering the care and service they need, when they need it.… more
- Brockton Hospital (Brockton, MA)
- …of Medicare and Medicaid programs, state insurance and health care laws, HITECH, HIPAA and general Corporate Compliance principles. Maintains up-to-date ... medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference...knowledge of health care legal requirements, and determines if policy revisions or… more
- Highmark Health (Boston, MA)
- …Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills ... but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid… more