- 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
- WellSense (Boston, MA)
- …with the physical health teams. Additionally, the Senior Director is responsibleand accountablefortheoverallstrategicdirectionoversight,analysis, clinical ... Senior Director of BH Clinical Programs...company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25… more
- Bristol Myers Squibb (Boston, MA)
- …love of challenge._ 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
- Fallon Health (Dartmouth, MA)
- …among the nation's top health plans for member experience, service, and clinical quality. Fallon Health's Summit ElderCare(R) is a Program of All-Inclusive Care ... be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Responsibilities** **Summary:**… 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
- Fallon Health (Dartmouth, MA)
- …**Brief Summary of Purpose:** Responsible for the coordination and supervision of all clinical and business aspects of a PACE site serving 100 participants or less. ... business administration. + Recruits and hires staff. Supervises and evaluates Clinical Nurse Manager, Social Workers, Supervisor of Support Services, Supervisor of… 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
- 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
- Prime Therapeutics (Boston, MA)
- …HS diploma or GED is required + 10 years of work experience in Medicare Star Rating quality programs, analytics, audit, compliance , operational compliance , ... and processes that drive Star ratings and measurable results. + Develop a comprehensive Medicare Star Ratings and CAHPS strategy that meets the needs of clients to… 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)
- …Security directs and manages Commonwealth Care Alliance's (CCA) efforts to ensure compliance with laws, regulations and policies that govern information privacy and ... and Accountability Act (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH), Omnibus Rulemaking, MA 201 CMR 17 (Massachusetts… 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)
- …Registered Nurse. The CQO is accountable to lead, support and guide the Senior Leadership team in matters related to regulatory requirements, quality, and patient ... including oversight of Joint Commission Survey Readiness, Performance Improvement, Clinical Quality, Quality Data Management, Patient Advocacy and HIPAA Privacy.… more