- 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
- Highmark Health (Boston, MA)
- …efficiencies. + Manage individual projects for timely review with the Director, Clinical Pharmacy. + Participate in Medicare Stars performance measures to ... as an adjunct to health coaching. If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case… 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
- Option Care Health (Boston, MA)
- …and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement. Experience evaluating information to determine compliance ... patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the… more
- Humana (Boston, MA)
- …Medical Director (Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults) works assignments involve moderately complex to complex ... Staff Geriatrician or Physician with Ten (10) Years of Clinical Practice with Older Adults (Medical Director) is dedicated...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… 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)
- …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)
- …desired, although not essential. + Familiarity with or knowledge of the Medicaid, Medicare , and dual-eligible landscape. + Experience in clinical care delivery, ... . The Sr. Medical Director, InstED is a key clinical leader and member of the instED management team,...such as annual reports to DPH, critical incident reporting, compliance issues, and to ensure optimal care delivery. +… 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
- 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)
- …Facilities, Chronic-Disease Rehabilitation Hospitals as well as two coordinated care programs, Senior Care Options (SCO) and the Program of All Inclusive Care for ... Program Integrity, and special project implementation. This work includes Compliance Management, Contract Management, Procurement, and Performance Management. * *… more