- 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
- 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
- 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)
- …our passion and drives every decision we make. **Job Posting Title** Client Quality Manager Stars and Quality - Remote **Job Description** The Senior Client Quality ... Manager ensures the successful planning, implementation and execution of...provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating… 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
- 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
- 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 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
- Point32Health (Canton, MA)
- …the Director, Customer Experience (CX), the CX Measurement & Improvement Program Manager is directly responsible for leading two heavily regulated annual survey ... programs and strategic improvement initiatives. The Customer Experience Program Manager is key role on the enterprise Customer Experience team and is responsible for… 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
- Molina Healthcare (Boston, 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
- Prime Therapeutics (Boston, MA)
- …management in the areas of problem identification and resolution, process improvements, compliance with Centers for Medicare & Medicaid Services (CMS) ... passion and drives every decision we make. **Job Posting Title** Vendor Program Manager Senior **Job Description** The Vendor Program Manager is responsible for… more
- Datavant (Boston, MA)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- **Technical Program Manager ** **Category:** Project Management **Main location:** United States, Massachusetts, Canton **Position ID:** J0625-0873 **Employment ... -Learn more (xweb.asp?clid=21001&page=cookiespolicy#integrationofyoutube) . **Position Description:** The Technical Program Manager collaborates with Executive and Business sponsors to successfully… more
- CGI Technologies and Solutions, Inc. (Boston, MA)
- **Senior Project Manager ** **Category:** Project Management **Main location:** United States, Massachusetts, Canton **Alternate Location(s):** United States, ... **Position Description:** CGI is seeking to hire an ePMO Program/Project Manager to work with Executive/Business sponsor to successfully implement new capabilities… more