- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as ... escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- Bristol Myers Squibb (Boston, MA)
- …. Reporting into the Medical Value Liaison Field Director, the Senior Medical Value Liaison (MVL)/Executive MVL is a field-based role focused ... on applying clinical expertise and experience/knowledge of payors, health policy, payer...policy makers, and other decision makers and influencers. **Responsibilities** ** Senior Medical Value Liaison** + Provide comprehensive, accurate, fair,… more
- Beth Israel Lahey Health (Boston, MA)
- …of America) Under the general direction of the Associate Director of the Clinical Trials Office (CTO), the Senior Contracting Specialist works with ... clinical research. + Understands and keeps current with FDA and Medicare regulations applicable to clinical trials. Implements rules, regulations, guidelines… more
- Humana (Boston, MA)
- …Clinical Pharmacy Review (HCPR) function. The role's responsibility will include compliance reporting ( Medicare & Medicaid), operations reporting, and expert ... part of our caring community and help us put health first** The Senior Data and Reporting Professional generates ad hoc reports, regular datasets, and visualizations… more
- Highmark Health (Boston, MA)
- …Act (ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid ... closely with colleagues, leadership, enterprise matrix partners (such as quality and compliance ), and/or physicians to identify and deliver high quality and accurate… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director, Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and ... senior management and/or the Board regarding Third-party Oversight Compliance Program effectiveness, initiatives, and issues, including all relevant metrics,… more
- Fresenius Medical Center (Waltham, MA)
- …developments. + Supports, as necessary, Leadership's collaboration with Corporate Compliance , Clinical Services, Operations, Quality, Education, and Corporate ... **PURPOSE AND SCOPE:** Manages a field team of regulatory compliance employees and provides regulatory expertise through leadership, collaboration, development,… more
- Novo Nordisk (Boston, MA)
- …Access accounts encompasses third party payers of Commercial, Medicaid and Medicare medical and prescription benefit plans. Customer channels and specific customers ... organizations, etc. + Customize strategies based on Commercial, Medicaid and Medicare demographics, legislation, and trends + Develop and implement strategies that… more
- Erickson Living (Hingham, MA)
- …the Erickson Senior Living community continuum of care + Following Medicare , state and federal regulations, APTA, and company policies and procedures and ensure ... Location: Linden Ponds by Erickson Senior Living Linden Ponds is a beautiful 108-acre...holistic approach, supporting the residents' physical, spiritual, emotional, and clinical needs + Providing day-to-day Physical Therapy treatments to… more
- Commonwealth Care Alliance (Boston, MA)
- …and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment, HCC, clinical and coding reviews; DRG and ... reviews and assessments that address a combination of financial, operational, governance/ compliance , clinical and technology/systems objectives. + Experience in… more
- Commonwealth Care Alliance (Boston, MA)
- …organization and performing objective analyses of strategic, financial, operational, governance/ compliance , clinical , technological, internal controls, and risk ... integrated audits that address a combination of financial, operational, governance/ compliance , clinical , and technology/systems objectives. + Demonstrated… more
- Commonwealth Care Alliance (Boston, MA)
- …stakeholders + Keeps current with emerging trends in hospital quality, safety, and clinical compliance , and integrates key concepts into daily operations. + ... to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid- Medicare Plan withhold measures, quality performance… more
- Commonwealth Care Alliance (Boston, MA)
- …Rhode Island Market Medical Director is an integral part of a mission-driven clinical and market team. The Medical Director's primary responsibilities are to ensure ... that the clinical processes that contribute to the Massachusetts Duals (SCO/OneCare)...and implements programs that improve the health of the senior dual eligible and MAPD population, including for dementia,… more
- State of Massachusetts (Tewksbury, MA)
- …and security measures across the hospital campus. Partnering closely with senior leadership and department supervisors, you will be integral in maintaining ... compliance with accreditation and regulatory standards while upholding the...as The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). Your expertise will be… more
- Tufts Medicine (Boston, MA)
- …using specialized knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job area typically ... or seminary. 2. Completion of two (2) units of Clinical Pastoral Education. 3. Three (3) years of Hospital...support. Completes an initial spiritual assessment as required by Medicare Conditions of Participation guidelines. 2. Based on assessment… more
- Commonwealth Care Alliance (Boston, MA)
- …members and providers, working collaboratively with leaders accountable for delivering clinical care and provider networks and contracting. Reporting directly to the ... Reports Include the Director of Member Service, Director of Provider Service, Senior Director of Member Communications, Manager of Training and Quality, Director of… more
- State of Massachusetts (Boston, MA)
- …as well as other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The ... and abuse, including identification and implementation of best practices, reporting compliance , claims data analysis, development of key performance indicators, and… more