- Commonwealth Care Alliance (Boston, MA)
- …strategic objectives. The Manager leads performance evaluation and improvement efforts, including reporting and data analysis, to ensure delegated entities meet ... full management responsibility for all performance measure components, including end-to-end data collection, evaluation, and timely dissemination of reports to both… more
- Commonwealth Care Alliance (Boston, MA)
- …management, (c) coordination of onboarding and training of related CBO staff, (d) data review, reporting and analysis, and (e)assistance to these external ... in meetings/calls with ASAPs and LTSC Agencies - Performance reporting / data management support o Link with CCA's...that CCA implements. - Working knowledge of Medicare and Medicaid (MassHealth) - Familiarity with and full support of… more
- Commonwealth Care Alliance (Boston, MA)
- …inquiries and facilitating collaborative discussions on improvement opportunities. **Performance Reporting & Data Management** + Partner with Quality ... on CCA's Population Health goals; including Medicare Star measures, Medicaid -Medicare Plan withhold measures, quality performance metrics incorporated into other… more
- Commonwealth Care Alliance (Boston, MA)
- …and outcomes, and leads performance evaluation and improvement efforts. Through reporting , data analysis, and partnership management, the LTSS Program ... and data accuracy, including roster reconciliation, payment processes, and reporting . + Manage special projects related to program development, process redesign,… more
- Commonwealth Care Alliance (Boston, MA)
- …strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged, ... facing staff apprised of messaging and timelines. + Present reporting and trends to the committee + Develop and...standards, and provider-friendly + Work with provider network and data management to influence how provider contact information is… more
- Commonwealth Care Alliance (Boston, MA)
- …in a matrixed environment. - Proficiency in Microsoft Office Suite; experience with data reporting tools preferred. - Ability to function independently and ... relationships with behavioral health providers and driving performance improvement through data insights, education, and partnership. This individual will serve as… more
- Commonwealth Care Alliance (Boston, MA)
- …- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) and comfort with data dashboards or reporting tools. - Ability to lead and facilitate ... and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. - Lead initiatives to streamline provider… more
- Commonwealth Care Alliance (Boston, MA)
- …utilization management issues and concerns and corrective action plan activities and reporting . - Provides expert input to Finance regarding patterns of utilization ... delivery Required Knowledge, Skills & Abilities: - Medicare and Medicaid managed care experience - Demonstrated knowledge of federal...required for the role, and other external and internal data when establishing a salary level. In addition to… more
- Commonwealth Care Alliance (Boston, MA)
- …operational excellence to enhance provider satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior ... a best-in-class provider experience. + Utilize strategic planning and data -driven insights to identify opportunities for continuous improvement in provider… more
- Commonwealth Care Alliance (Boston, MA)
- …progress across the portfolio of strategic growth efforts - Helps build reporting and governance structures for initial oversight. Works to identify, escalate and ... field is a plus Desired Licensing (nice to have): - Project Management Professional (PMP) certification - Six Sigma or equivalent certification - Agile/scrum master… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is ... the Utilization management process, including understanding of CMS and state Medicaid regulations. + Ability to work independently **Desired Knowledge, Skills,… more
- Humana (Boston, MA)
- …our organization's standing within the Medicaid markets. **Complex Ad-Hoc Requests:** The Data and Reporting Professional 2 will address complex ad-hoc ... caring community and help us put health first** The Medicaid Data and Reporting Analyst...operating objectives, including their linkages to related areas. The Data and Reporting Professional 2… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Medicaid Process Improvement Professional 2 is responsible for analyzing and evaluating the ... and regulatory standards. Assignments are varied and often require interpretation of Medicaid -specific policies and data . The role demands independent judgment… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and ... Requires strong project management skills to evaluate the downstream impacts of data changes on actuarial models, reporting tools, and financial results.… more
- Humana (Boston, MA)
- …and Medicaid program requirements to drive accurate and timely submissions. The Senior Data and Reporting Professional integrates data from multiple ... operations across multiple states. This role ensures compliance with state-specific Medicaid reporting implementations and requirements, will collaborate with… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications **Required ... Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports...& Abilities (must have):** + Proficiency with Excel and reporting tools for data analysis. + Understanding… more
- Humana (Boston, MA)
- …contracting requirements and data integrity as required in the Ohio Medicaid Provider Agreement and internal reporting compliance. This role will support ... contracting governance, process development, and data governance Ohio Medicaid , including developing contracting requirements, internal reporting compliance… more
- Humana (Boston, MA)
- … requires an in-depth evaluation of variable factors. The Senior Workforce Management Professional plays a pivotal role in supporting Medicaid Inpatient and ... community and help us put health first** The Senior Workforce Management Professional applies and integrates advanced and predictive analysis, people metrics and … more
- Humana (Boston, MA)
- …model designs including analyzing provider performance, reporting , and scorecard/reconciliation reporting . + Understanding of Medicaid and/or Medicaid ... first** Humana Healthy Horizons is seeking a Senior Value-Based Programs professional who will support successful value-based provider relationships with a focus… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Senior Agency Management Professional provides support for handling and analyzing data that pertains to ... determination of the appropriate courses of action. The Senior Agency Management Professional provides support for handling and analyzing data that pertains… more
