- Highmark Health (Boston, MA)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Sumitomo Pharma (Marlborough, MA)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Humana (Boston, MA)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Amazon (Boston, MA)
- …in PBM, health insurance, pharmacy, business development, marketing, managed care, Medicaid , Medicare Part D, and commercial innovation. - Bachelor's degree in ... including Operations, Marketing, Account Services, Tech, Product, Legal, and Compliance . - Demonstrate clear, concise, written and oral communication. Amazon… more
- Point32Health (Canton, MA)
- …to our members, partners, colleagues and communities. **Job Summary** The Lead Compliance Program Manager will be responsible for development, implementation and ... well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with… more
- Prime Therapeutics (Boston, MA)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- Prime Therapeutics (Boston, MA)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Commonwealth Care Alliance (Boston, MA)
- …adhering to regulatory and contractual requirements. * Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead ... facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing...* Ability to lead audit readiness efforts and ensure compliance with CMS, NCQA and state Medicaid … more
- Prime Therapeutics (Boston, MA)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- Pearson (Boston, MA)
- …path through this shifting environment to achieve continued success.** _Purpose Summary_ _The Medicaid and Vendor Implementation Manager will act as the main ... Pearson Virtual Schools' Connections Academy programs. Responsibilities include ensuring compliance with federal and state Medicaid regulations, optimizing… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- **ePMO Project Manager ** **Category:** Project Management **Main location:** United States, Massachusetts, Canton **Position ID:** J0625-0840 **Employment Type:** ... -Learn more (xweb.asp?clid=21001&page=cookiespolicy#integrationofyoutube) . **Position Description:** The ePMO Program/Project Manager collaborates with Executive and Business sponsors to successfully… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The **Telephonic Nurse Case Manager ** will be a member of the Case Management Team, providing a comprehensive, ... holistic approach for case management throughout the continuum of care. The case manager will offer guidance. support, and coordination of the beneficiary's care as… more
- CVS Health (Boston, MA)
- …team with Aetna, a CVS Health company. As a Senior Program Manager for Interoperability, you will be responsible for product post-production support of ... Interoperability team, you will work collaboratively with Business, Clinical, Architecture, Compliance , IT, and Legal to deliver technologies and processes that… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Senior Data Manager supports all aspects of configuration control, data management, and deficiency reporting. ... The Senior Data Manager work assignments involve moderately complex to complex issues...Migration -- Planning and executing data migration projects. + Compliance -- Ensuring compliance with data protection… more
- CenterWell (Boston, MA)
- …part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to ... and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require interpretation and… more
- Humana (Boston, MA)
- …organization and will be critical in our growth plans. The Principal Product Manager Leads all phases of the product life cycle, from inception to introduction ... Curiosity and a human-centered approach will drive the Product Manager to find relevant data and turn it into...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Commonwealth Care Alliance (Boston, MA)
- …Supervision Exercised: No **Essential Duties & Responsibilities** + Understand, and assure compliance to and adherence with, Medicaid and Medicare enrollment, ... documents and conducts procedures related to the reconciliation of Medicaid and Medicare enrollment membership and corresponding premium. The Specialist… more
- Sanofi Group (Cambridge, MA)
- **Job Title:** Rare Blood Trade Account Manager **Location:** Remote/Field **About the Job** The Rare Blood Trade Account Manager reports to the Director, ... accounts. + Apply strong judgment and oversight to ensure integrity and compliance with company policies in all activities and communications. **Key Performance… more
- Humana (Boston, MA)
- …we expand our cloud capabilities, we are looking for a Principal Product Manager to lead our multi-CSP strategy, drive cross-domain collaboration, and optimize our ... customer onboarding experience. As a Principal Cloud Platform Product Manager , you will own the vision, strategy, and execution for our multi-cloud platform-focusing… more
- Molina Healthcare (Cambridge, MA)
- …of illness and the site of service. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of integrated ... more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards and… more