- Highmark Health (Boston, MA)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Humana (Boston, MA)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Point32Health (Canton, MA)
- …to our members, partners, colleagues and communities. **Job Summary** The Lead Compliance Program Manager will be responsible for development, implementation and ... well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with… more
- Prime Therapeutics (Boston, MA)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- Prime Therapeutics (Boston, MA)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Commonwealth Care Alliance (Boston, MA)
- …adhering to regulatory and contractual requirements. * Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead ... facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing...* Ability to lead audit readiness efforts and ensure compliance with CMS, NCQA and state Medicaid … more
- Humana (Boston, MA)
- …health outcomes for our dual members - members that qualify for both Medicare and Medicaid . The Lead Product Manager sits in the center of strategy, design, ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** Client Quality Manager Stars and Quality - Remote **Job Description** The Senior Client Quality ... Manager ensures the successful planning, implementation and execution of...provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating… more
- Aveanna Healthcare (Worcester, MA)
- RN Clinical Manager ApplyRefer a FriendBack Job Details Requisition #: 204886 Location: Worcester, MA 01606 Category: Clinical Care and Support Salary: $100,000.00 ... per year Position Details Clinical Manager - Aveanna Healthcare - Worcester, MA Are you...standards, and Aveanna policies to ensure top-tier care and compliance . + Provide On-Call Leadership:Be a consistent, reliable resource… more
- Prime Therapeutics (Boston, MA)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- **ePMO Project Manager ** **Category:** Project Management **Main location:** United States, Massachusetts, Canton **Position ID:** J0625-0840 **Employment Type:** ... -Learn more (xweb.asp?clid=21001&page=cookiespolicy#integrationofyoutube) . **Position Description:** The ePMO Program/Project Manager collaborates with Executive and Business sponsors to successfully… more
- Aveanna Healthcare (Worcester, MA)
- …functions associated with all operations of an Aveanna branch. Additionally, Operations Manager is responsible for initiating and maintaining compliance with all ... Home Health Branch Manager ApplyRefer a FriendBack Job Details Requisition #:...State regulations governing Home Health Care Agencies and ensuring compliance with Aveanna's policies and procedures. Other Duties: +… more
- Fallon Health (Worcester, MA)
- …Regulatory Manager is an essential function to Fallon Health's compliance with CMS regulations, NCQA standards, EOHHS applicable regulatory requirements, and ... of CMS, spotlight, IPRO, NCQA and other applicable regulatory and internal- compliance audits. **Responsibilities** **Care Management (CM) Regulatory Manager … more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... to teach assessment processes, care pathways, and other workflows required by the Care Manager positions * Works with Leaders to ensure the new hire is proficient in… more
- Point32Health (Canton, MA)
- …the Director, Customer Experience (CX), the CX Measurement & Improvement Program Manager is directly responsible for leading two heavily regulated annual survey ... programs and strategic improvement initiatives. The Customer Experience Program Manager is key role on the enterprise Customer Experience team and is responsible for… more
- Humana (Boston, MA)
- …of Case Management team on cases with support needs. Ensures regulatory compliance by aligning care management policies, procedures, and processes to maintain ... initiatives to maintain focus on performance goals and standards, quality and compliance measures with development of action plans to improve results. + Ensures… more
- Fallon Health (Milford, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care… more
- Commonwealth Care Alliance (Boston, MA)
- …Supervision Exercised: No **Essential Duties & Responsibilities** + Understand, and assure compliance to and adherence with, Medicaid and Medicare enrollment, ... documents and conducts procedures related to the reconciliation of Medicaid and Medicare enrollment membership and corresponding premium. The Specialist… more
- Humana (Boston, MA)
- …we expand our cloud capabilities, we are looking for a Principal Product Manager to lead our multi-CSP strategy, drive cross-domain collaboration, and optimize our ... customer onboarding experience. As a Principal Cloud Platform Product Manager , you will own the vision, strategy, and execution for our multi-cloud platform-focusing… more
- Sanofi Group (Cambridge, MA)
- **Job Title:** Rare Blood Trade Account Manager **Location:** Remote/Field **About the Job** The Rare Blood Trade Account Manager reports to the Director, ... accounts. + Apply strong judgment and oversight to ensure integrity and compliance with company policies in all activities and communications. **Key Performance… more