- Abby Care (Boston, MA)
- …care at scale. Compliance & Quality Control -You'll own HIPAA and Medicaid compliance across operations, as well as internal documentation standards. This ... strategic, data-driven, and highly organized individual to join us as a Care Operations Manager . This role will report into the Associate General Manager of… more
- US Tech Solutions (Canton, MA)
- …coverage for multiple products / lines of business; such as state specific Medicaid and Senior Products (Medicare Advantage and SCO). The Clinical Reviewer ensures ... and timely disposition of coverage decisions as required by product specific compliance and regulatory time frames. The Clinical Reviewer functions as a member… more
- Sumitomo Pharma (Providence, RI)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Humana (Providence, RI)
- …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
- Amazon (Boston, MA)
- …in PBM, health insurance, pharmacy, business development, marketing, managed care, Medicaid , Medicare Part D, and commercial innovation. - Bachelor's degree in ... including Operations, Marketing, Account Services, Tech, Product, Legal, and Compliance . - Demonstrate clear, concise, written and oral communication. Amazon… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the direction of the Director or Senior Manager of the department, the Compliance Program Manager ... analytical skills. By using knowledge of the company, the Compliance Program Manager III should be able...of education and experience . 3+ years of Medicare, Medicaid and/or commercial compliance experience. + Preferred:… more
- Prime Therapeutics (Providence, RI)
- … 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
- J&J Family of Companies (Boston, MA)
- …Description:** We are searching for the best talent for a Therapy Access Manager in our Boston territory. **About Innovative Medicine** Our expertise in Innovative ... Engagement and Customer Solutions (PECS) team is recruiting for a Therapy Access Manager which will be a field-based position. PECS is committed to setting the… 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
- Sanofi Group (Providence, RI)
- **Job Title:** Field Reimbursement Manager Tzield- Northeast Region **Location:** Remote **About the Job** The individual in this role will need to demonstrate a ... requires dedicated and knowledgeable customer facing support. Field Reimbursement Manager /Director for TZIELD. This is a regionally aligned, field-based position… more
- Fallon Health (Brockton, 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
- Fallon Health (Brockton, 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 ... LinkedIn. **Brief summary of purpose:** The Accountable Care Organization (ACO) Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on… more
- Molina Healthcare (Boston, MA)
- …of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of integrated ... more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and… 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
- BD (Becton, Dickinson and Company) (Warwick, RI)
- …self. Become a **maker of possible** with us. **Job Overview:** The **Senior Manager - Payer Relations, Market Access (PRMA)** is a very important customer-facing ... (PRS) platform, within BD's Surgery business unit. The Senior Manager is required to establish new or revise existing...key technologies with regional commercial health plans, and State Medicaid Agencies + Work cross functionally with key account… more
- Gentiva (Warwick, RI)
- **Overview** We're looking for a **Patient Care Manager ** to join our team.You will report directly to the Executive Director, Administrator, or Senior Patient Care ... Manager . You will be responsible for maintaining a high...and ensuring adherence to company policies and procedures and compliance with local, state, and federal regulations and regulatory… more
- Datavant (Providence, RI)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- **Technical Program Manager ** **Category:** Project Management **Main location:** United States, Massachusetts, Canton **Position ID:** J0625-0873 **Employment ... -Learn more (xweb.asp?clid=21001&page=cookiespolicy#integrationofyoutube) . **Position Description:** The Technical Program Manager collaborates with Executive and Business sponsors to successfully… more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Manager , Technology Solutions devises an effective strategy for executing and delivering on IT ... business initiatives. The Manager , We are seeking a highly skilled and motivated...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
