- Commonwealth Care Alliance (Boston, MA)
- …Department Regulatory Affairs and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid ... Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an… more
- Amazon (Boston, MA)
- …and position ourselves in becoming the world's safest and fastest online pharmacy. The Senior Product Manager - Technical role is a high-impact role with ... new features in the areas of claims, billing, and compliance . This role will be responsible for leading Medicaid...This role will be responsible for leading Medicaid and Medicare growth strategies for Amazon Pharmacy, and delivering products… more
- Humana (Boston, MA)
- …Performing utilization management activities for assigned areas. Ensures full compliance with contract requirements, policies and procedures, and performance ... for ACD participants. + Review ABA TPs for policy compliance + Review pend queues for pended authorizations +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Reporting to the Sr Director, **Quality Performance and Value Based Care,** the Provider and Facility Quality & Safety ... Manager is responsible for designing and executing quality measurement...achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid- Medicare Plan withhold measures,… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Lead Compliance Program Manager will be responsible for development, ... well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with… more
- Beth Israel Lahey Health (Boston, MA)
- …of the Associate Director of the Clinical Trials Office (CTO), the Senior Contracting Specialist works with investigators, clinical trial coordinators and industrial ... clinical research agreements in accordance with BIDMC' institutional policies. The Senior Contracting Specialist provides orientation, training and mentoring to CTO… more
- Humana (Boston, MA)
- …(Supervisor, Manager or above) experience + Strong knowledge of Medicare and Medicaid standards and regulations + Strong attention to detail, organizational ... caring community and help us put health first** The Manager , Grievance and Appeals ensures that products meet certain...to improve the organization's efficiency and accuracy related to Medicare Part C/D Grievance and Appeals and to minimize… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Senior Product Owner will review documentation and provide feedback on quality and accuracy related to the product portfolio ... new technology opportunities to attain operational efficiencies and growth opportunities. The Senior PO will lead a portfolio of projects and enhancements, and build… 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 ... with field sales forces are accomplished. Essential Functions + Regional account manager (ram) coaching: + Ensure that RAMs understand their level of accountability… more
- Highmark Health (Boston, MA)
- …Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Business Systems Analysts, as well as others outside of immediate ... limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager , or Tester, based upon experience and need. + Provide required… more
- Humana (Boston, MA)
- …data encryption and encryption key management protocols + Enterprise Security Compliance - In depth understanding of enterprise network and infrastructure security, ... data security, governance, and privacy requirements for HIPAA, and SOC compliance + DevOps -- hands-on experience with modern CICD automation eco-systems such as… 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
- Commonwealth Care Alliance (Boston, MA)
- …programs. 3) In collaboration with their supervisor and Market General Manager , works with external stakeholders including network providers and facilities to ... leadership, creates and implements programs that improve the health of the senior dual eligible and MAPD population, including for dementia, chronic disease… more