- Humana (Boston, MA)
- …such as inpatient rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or ... of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or Medicaid...board certified in Psychiatry** + 5+ years of direct clinical patient care experience post residency or… more
- Humana (Boston, MA)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... value-based care and innovation with internal and external providers +...provider engagement activities for all lines of business + Medicare Advantage experience **Additional Information** This position… more
- Humana (Boston, MA)
- …to identify and address business issues and opportunities related to the high-needs Medicare Advantage (MA) and Special Needs Plan (SNP) populations that benefit ... to analyze complex problems and issues related to our Medicare Advantage population using data and insight...clinical and/or operations + Exposure or experience with clinical care delivery and interventions **Additional Information**… more
- Humana (Boston, MA)
- …solutions to improve clinical outcomes and lower costs for millions of Medicare Advantage beneficiaries leveraging data science & analytics, clinical ... such as EMR, Episode grouper, utilization management, value-based care , low value care etc. + Familiarity with clinical concepts related to a broad range… more
- Commonwealth Care Alliance (Boston, MA)
- …experience working in health care preferred. + Experience with a Medicare Advantage population preferred. + Experience with Substance Use Disorders ... Role is Important to Us:** As part of the care management dyad, the Care Coordinator works...the year + Support needs for local/team/pod trainings or clinical seminars + Assists CCA leadership with the development,… more
- Humana (Boston, MA)
- …such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or ... conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements...MD or DO degree + 5+ years of direct clinical patient care experience post residency or… more
- Humana (Boston, MA)
- …(such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand… more
- Humana (Boston, MA)
- …such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,...of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise… more
- Commonwealth Care Alliance (Boston, MA)
- …Home Health Care experience + 2 or more years working in a Medicare Advantage health Plan **Required Knowledge, Skills & Abilities (must have):** + Ability ... **Why This Role is Important to Us:** Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization)... areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports… more
- Humana (Boston, MA)
- …and acute inpatient rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid, or ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand… more
- Highmark Health (Boston, MA)
- …locations and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint. Designs, implements and executes strategies ... and works with cross-functional clinical , pharmaceutical, operational, IT and Performance Management improvement teams...met and to optimize outcomes. Collaborates with the company's Medicare Advantage matrixed teams to improve processes,… more
- CVS Health (Boston, MA)
- …Medical Director will be responsible for provider education regarding best clinical practices, utilization management, care management, claims adjudication, ... quality improvement, grievance and appeals, policies and procedures, and responsible health care expenditure to improve clinical outcomes. They will help lead… more
- Cardinal Health (Boston, MA)
- …regarding managed care contracts. This includes coordination of commercial, Medicare Advantage , Managed Medicaid and other third-party managed care ... mission is to empower community oncology practices to deliver patient-centered cancer care . Navista, a Cardinal Health company, is an oncology practice alliance… more
- Harvard University (Cambridge, MA)
- … management and policy research projects, such as the following: A) Comparing Medicare Advantage and Traditional Fee-for-Service Medicare B) Variations in ... use agreements, and preparing and delivering presentations for academic, clinical , and grantor audiences. + Track progress of each...the Quality of Cost of Care for Dual-Eligible Medicare and Medicaid Beneficaries… more
- CVS Health (Boston, MA)
- … clinical , analytic, and consultative skills to join our team of Medicare Advantage Manager, Business Consultants (MANAGER, BUSINESS CONSULTANT) who offer ... we serve. **Required Qualifications** * 5+ years' experience in a clinical /healthcare setting (3+ years in acute care , the other 2+ years may be a combination of… more
- Humana (Boston, MA)
- …with Six Sigma and/or the Project Management Institute + Knowledge of Medicare Advantage **Scheduled Weekly Hours** 40 **Pay Range** The compensation ... ensure vendors meet contractual obligations as part of the Medicare Prescription Payment Plan program. The M3P program will...we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as… more
- Humana (Boston, MA)
- …+ Bachelor's Degree or Master's of Business Administration (MBA) + Value-Based Healthcare + Medicare Advantage Bid knowledge + Knowledge of Service Fund + Power ... evaluation of variable factors. This position will support MRA, clinical , and quality teams in identifying trends and opportunities...serve to achieve their best health - delivering the care and service they need, when they need it.… more
- Brockton Hospital (Brockton, MA)
- …of Medicare and Medicaid programs, state insurance and health care laws, HITECH, HIPAA and general Corporate Compliance principles. Maintains up-to-date ... should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the… more
- North Shore Community Health (Peabody, MA)
- … clinical support staff by providing the safest and highest quality patient care possible. Physicians will support all other clinical staff with assessments, ... a Physician. Under the general direction of the Chief Clinical Officer (CCO) and the direct supervision of the...Director, the physician will provide continuing and comprehensive health care for the individual and family across all ages… more
- North Shore Community Health (Salem, MA)
- …* High School Diploma * Must have one year of experience in a health care setting * Understanding of Medicare , Medicaid and managed health care ... serving the surrounding communities with comprehensive and culturally sensitive care . With a strong commitment to excellence, NSCH provides:...day one, and all eligible staff members can take advantage of these benefits right from the start of… more