- CVS Health (Boston, MA)
- …implementation of large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare ... plan types. Manage staffing planning and development activities across teams. Represent Clinical Product strategic issues with Senior Managers and Markets… more
- WellSense (Boston, MA)
- Senior Manager of Clinical UM - BH WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through ... that works for our members, no matter their circumstances. **Job Summary:** The Senior Manager of Clinical Utilization Management (UM), Behavioral Health is… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Senior Vendor Management Professional will work as liaison between vendors and Humana supporting ... areas while helping ensure vendors meet contractual obligations as part of the Medicare Prescription Payment Plan program. The M3P program will provide all … more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director, Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and ... senior management and/or the Board regarding Third-party Oversight Compliance Program effectiveness, initiatives, and issues, including all relevant metrics,… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position** **Overview:** As a Senior Product Manager, within theclaimsvalue stream forHealthRulesPayor, you will have ownership of system ... specifically designed to fuel a digital transformation, reduce costs, and improve both clinical outcomes and the member experience. **Your Impact** **: ** + Develop… more
- Beth Israel Lahey Health (Boston, MA)
- …liaison for the clinical staff as it relates to coding and compliance . Interacts with physicians and other professional staff on documentation issues related to ... with any changes in ICD-10 and CPT-4 coding and remains current with Medicare , federal insurance and third party billing compliance regulations. Works… more
- HealthEdge Software Inc (Boston, MA)
- …payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration ... designed to fuel a digital transformation, reduce costs, and improve both clinical outcomes and the member experience. **Your** **I** **mpact** **:** + Product… more
- CVS Health (Boston, MA)
- …leadership to various internal departments (eg, specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance , Legal, ... of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of… more
- Commonwealth Care Alliance (Boston, MA)
- …organization and performing objective analyses of strategic, financial, operational, governance/ compliance , clinical , technological, internal controls, and risk ... integrated audits that address a combination of financial, operational, governance/ compliance , clinical , and technology/systems objectives. + Demonstrated… more
- Highmark Health (Boston, MA)
- …to support STARs performance, and provider incentive programs in partnership with senior leadership for the Medicare Advantage Quality Consultants. Partner to ... and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint. Designs, implements and executes strategies and works… more
- Erickson Living (Hingham, MA)
- …the Erickson Senior Living community continuum of care + Following Medicare , state and federal regulations, APTA, and company policies and procedures and ensure ... Location: Linden Ponds by Erickson Senior Living Linden Ponds is a beautiful 108-acre...holistic approach, supporting the residents' physical, spiritual, emotional, and clinical needs + Providing day-to-day Physical Therapy treatments to… more
- Point32Health (Canton, MA)
- …Director is responsible for ensuring achievement of Point32Health corporate goals; compliance with Point32Health business rules; oversight of all aspects of ... development, implementation and refinement of effective business processes that support compliance with relevant regulatory requirements (such as CMS, DOI, NCQA,… more
- Erickson Living (Hingham, MA)
- …Providing a holistic approach, supporting the residents' physical, spiritual, emotional, and clinical needs + Following Medicare , state, and federal regulations, ... Location: Linden Ponds by Erickson Senior Living Linden Ponds is a beautiful 108-acre...company policies, and procedures and ensuring departmental understanding and compliance in the areas of care provision, documentation, billing… more
- Commonwealth Care Alliance (Boston, MA)
- …Role is Important to Us:** **Position Summary:** Reporting to the Chief Risk, Compliance & Ethics Officer, the Vice President, Chief Privacy & Security Officer ... oversight, auditing, monitoring, and ongoing operation of CCA's privacy and security compliance assuring that it meets all requirements of applicable federal and… more
- Commonwealth Care Alliance (Boston, MA)
- …represent the company to a variety of audiences + Experience with managing clinical services for Medicaid/ Medicare patients + Demonstrated ability to lead and ... and supports to ensure achievement of business results while maintaining compliance with all contract requirements, state and federal regulatory requirements and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …the highest level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The Risk Manager plays ... and standard setting agencies. The Risk Manager performs as an internal compliance consultant by maintaining current knowledge of hospital regulations including DPH,… more
- Tufts Medicine (Boston, MA)
- …using specialized knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job area typically ... or seminary. 2. Completion of two (2) units of Clinical Pastoral Education. 3. Three (3) years of Hospital...support. Completes an initial spiritual assessment as required by Medicare Conditions of Participation guidelines. 2. Based on assessment… more
- Commonwealth Care Alliance (Boston, MA)
- …stakeholders include but are not limited to: quality; regulatory affairs/ compliance ; clinical , operations, pharmacy, dental, reporting, and member ... Grievances team in a number of ways to ensure compliance on activities related to member complaints in the...strict deadlines. - When necessary collaborate with care teams, clinical staff, family members, and other involved in providing… more
- State of Massachusetts (Boston, MA)
- …as well as other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The ... and abuse, including identification and implementation of best practices, reporting compliance , claims data analysis, development of key performance indicators, and… more