- Commonwealth Care Alliance (Boston, MA)
- …against internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. - Lead initiatives to ... operations , education, and performance improvement. The Provider Relations Director reports to the Sr Director of... and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations , including regulatory and… more
- Commonwealth Care Alliance (Boston, MA)
- …processes and functions. - Ensures compliance with all contract requirements, state and federal regulatory requirements and all applicable accreditation standards in ... ensure quality, interrater reliability and standards are met in daily operations . Responsible for resolution and communication of utilization management issues and… more
- Commonwealth Care Alliance (Boston, MA)
- …behavioral health, and/or social needs. + Strong understanding of **Medicare, Medicaid (MassHealth), and dual-eligible program operations ** , including ... external provider relationships are high-performing, well-coordinated, and fully integrated with CCA operations so that members' LTSS needs are met in a manner that… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... on CCA's Population Health goals; including Medicare Star measures, Medicaid -Medicare Plan withhold measures, quality performance metrics incorporated into other… more
- Commonwealth Care Alliance (Boston, MA)
- …cross-functional projects and meeting deadlines. + Strong understanding of Medicare, Medicaid , duals program, and health plan operations , including regulatory ... foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged,… more
- Commonwealth Care Alliance (Boston, MA)
- …in alignment with clinical licensure. - Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations , including regulatory and ... quality care. The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement. Supervision Exercised: - No,… more
- Commonwealth Care Alliance (Boston, MA)
- …satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will: + ... subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience with… more
- Humana (Honolulu, HI)
- …understanding of how organization capabilities interrelate across department(s). The Associate Director , Procurement complies with federal and state regulatory ... analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee meetings (ex; operations , quality, etc.). + Partner with… more
- Elevance Health (Durham, NC)
- **Utilization Management Medical Director - NC Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required ... of experience providing health care is required. Additional experience may be required by State contracts or regulations if the Medical Director is filing a role… more
- Humana (Oklahoma City, OK)
- …or related field. + Certified Public Accountant (CPA) credential. + Prior experience in Medicaid or state partnership financial operations . + Experience with ... an impact** **Key Responsibilities** + Provides market specific financial leadership in the State Medicaid Market, developing a deep understanding of Humana's … more
- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and… more
- NTT DATA North America (Albany, NY)
- …Operations & Systems The Senior Solution Architect will report to the Technology Director for the Division of Operations and Systems and have responsibility ... to the cloud while ensuring minimal disruption to ongoing operations + Designs, implements, and manages containerized solutions, involving...or local level as well as experience working with Medicaid programs in New York State +… more
- CVS Health (Chicago, IL)
- …and oversees compliance within our network responsibilities as provided within the state Medicaid contractual requirements. This position holds a variety of ... as for internal staff that aligns PE/Network functions with Operations and Claims as needed + Research, review, and...policies. Review departmental policies and submit for approval. Assist Director with State /NCQA Audits gathering details for… more
- New York State Civil Service (Ogdensburg, NY)
- …be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists. If appointed and subsequently listed as ... HELP No Agency Mental Health, Office of Title Deputy Director , Psychiatric Center 1 - Operations , St....Operations - SLPC 44 Holland Avenue City Albany State NY Zip Code 12229 Notes on Applying Qualified… more
- Commonwealth Care Alliance (Boston, MA)
- …will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. Analyst plays ... the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible… more
- New York State Civil Service (NY)
- …Agency People With Developmental Disabilities, Office for Title Developmental Disabilities Operations Director 1 Occupational Category Administrative or General ... County To Be Determined Street Address TBD City TBD State NY Zip Code 00000 Duties Description The Regional... NY Zip Code 00000 Duties Description The Regional Director position carries unique and specialized responsibilities that are… more
- The Joint Commission (Washington, DC)
- …offices and agencies. + Under direction of Director , builds relationships with Medicaid offices and state public health programs and assists Director ... the state policy-related strategy for Joint Commission. Under direction of Director , manages the state relations, including the collection, monitoring, and… more
- Ascendis Pharma (Princeton, NJ)
- …and develop their skills. Ascendis Pharma is looking to hire an experienced Director , Market Access Contract Operations to join our team. Responsibilities will ... tactical, demonstrating strong leadership, project management, and communication skills. As the Director , Market Access Contract Operations , you will oversee all… more
- New York State Civil Service (Albany, NY)
- …State NY Zip Code 12224 Duties Description Criminal Justice Division Medicaid Fraud Control Unit - Albany-areaDeputy Director , Electronic Investigative ... a complete application online at ag.ny.gov/job-postings/otherThe Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) is… more
- Humana (Olympia, WA)
- …part of our caring community and help us put health first** The Associate Director , HEDIS Operations of Non-Standard Supplemental for business operations ... of how organization capabilities interrelate across department(s). The Associate Director of HEDIS Non-Standard Supplemental Operations supports all… more
