- CVS Health (Boston, MA)
- …implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of ... large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare PDP, MAPD and employer… more
- HealthEdge Software Inc (Boston, MA)
- …adopt digital transformation and innovation + 7+ years' experience with healthcare compliance /regulations - Medicare , Medicaid, federal and state requirements + ... Looking for a subject matter expert in the healthcare regulatory & compliance space, with acumen and passion for leveraging innovative technology to solve… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Elevance Health (Woburn, MA)
- ** Director of Contracts & Procurement** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Highmark Health (Boston, MA)
- …and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint. Designs, implements and executes strategies and works ... Organization are met and to optimize outcomes. Collaborates with the company's Medicare Advantage matrixed teams to improve processes, procedures and best practices.… more
- Prime Therapeutics (Boston, MA)
- …decision we make. **Job Posting Title** Senior Financial Analyst - Remote **Job Description Summary** This position requires significant financial analytical ... and resolving complex problems and issues. + If supporting Medicare Part D, will be responsible for implementing CMS...focus **Reporting Structure** + Reports to Manager or Sr Director in the Finance department **Responsibilities** + 3+ years… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range of ... actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Physician Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and ... review process so as to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as URAC and...+ On a requested basis, may function as Medical Director for select health plans or regions, assuming overall… more
- Beth Israel Lahey Health (Boston, MA)
- …remains current with Medicare , federal insurance and third party billing compliance regulations. Works collaboratively with the Director and coders to ensure ... codes including the appropriate use of modifiers to ensure compliance for reimbursement. **Job Description:** **Essential Responsibilities:** 1. Coordinates coding… more
- Commonwealth Care Alliance (Boston, MA)
- …Important to Us:** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance , Healthcare Medical Claims Coding ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics… more
- Takeda Pharmaceuticals (Boston, MA)
- …strategy for all payer segments in the US, including but not limited to: Medicare national (Centers for Medicare & Medicaid Services [CMS]), Medicaid (state and ... managed), Medicare Part B regional carriers, Medicare Part...activities. Specifically, work collaboratively with Commercial, Medical Affairs, Legal, Compliance , Regulatory, Government Affairs, Finance, and Insight & Analytics… more
- WellSense (Boston, MA)
- …health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as ... and team performance, clinical program performance, team processes and compliance are essential. Working with his or her staff,...Senior Manager will work in conjunction with the Senior Director of Behavioral Health (BH) Clinical Programs on a… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Quality and Patient Safety (QPS) Department. Under the direction of the Director of Risk Management, the Risk Manager is responsible for identification, evaluation, ... level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The...is hybrid with two or three days per week remote . The selected candidate may only work remote… more