- Elevance Health (Woburn, MA)
- ** Director I Medicare Operations ** **Location:** This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of ... and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations ** is responsible for directing multiple business function… more
- Humana (Boston, MA)
- … Director is responsible for behavioral health care strategy and/or operations . The Behavioral Health Medical Director work assignments involve moderately ... requires an in-depth evaluation of variable factors. The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, leading, and ... modifying the business processes and operations for all levels of utilization management review (ie,...Inpatient & Outpatient) for Point32Health's lines of business. The Director is responsible for ensuring achievement of Point32Health corporate… more
- State of Massachusetts (Boston, MA)
- The Deputy Program Integrity Director is a policy, people and operational leader within the Program Integrity Unit of MassHealth. The Program Integrity Unit is a ... of MassHealth members. The team is led by the Director of Program Integrity, who reports to the Deputy...state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office… more
- Brockton Hospital (Brockton, MA)
- …(CCO) with the institutional compliance program planning and execution. The Assistant Director will utilize prior hospital operations experience in support of ... the lives and health of our patients. The Assistant Director , Corporate Compliance (Assistant Director ) is a...when needed. + Utilize strong background in hospital/health systems operations to contribute to an effective compliance program. +… 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 Risk ... Operations , and leads the Third-Party Compliance Oversight department for...compliance oversight and monitoring of delegated third parties including Medicare FDR; Duals/SNP; and Medicaid/LTSS programs. + Coordinates and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical health services ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… more
- Cardinal Health (Boston, MA)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Director , Broker Digital Sales (Innovation Portfolio Strategy) utilizes ideas, identifies innovation ... opportunities, and translates ideas into actionable and profitable business. The Director , Innovation Portfolio Strategy requires an in-depth understanding of how… more
- Humana (Boston, MA)
- …Medical Director responsible for behavioral health care strategy and/or operations . The Behavioral Health Medical Director work assignments involve ... Reporting Relationship: This position reports directly to the Cluster Lead Medical Director . **Use your skills to make an impact** **REQUIREMENTS:** + Doctor of… 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
- Advocates (Framingham, MA)
- …to regional director and clinic directors in support of clinic operations to ensure the provision of high-quality care. + Provides clinical supervision, ... the ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' Behavioral Health… more
- Humana (Boston, MA)
- …Best Places to Work, and be a part of our dynamic team as the Director of Technology Solutions. We are on a mission to revolutionize our Customer Relationship ... your chance to make a substantial impact! As the Director of Technology Solutions, you will spearhead the strategy...of IT initiatives that are vital to our business operations . Your deep understanding of organizational capabilities and your… more
- Gentiva (Auburndale, MA)
- …in people's lives every day. **Overview** We are looking for an **Executive Director Specialist RN** that will travel to many of our branch locations throughout ... complying with all federal and state guidelines. + Experience in hospice operations , state and federal regulations and compliance + Registered Nurse required, BSN… more
- HealthEdge Software Inc (Boston, MA)
- …them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other ... particularly in the Payer space, with a perspective on how health plan operations impact willingness to adopt digital transformation and innovation + 7+ years'… more
- Commonwealth Care Alliance (Boston, MA)
- …to Us:** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… 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...prioritized access segments and customers; + Manage Field Access Director team supporting physician office reimbursement access issues; support… more
- Prime Therapeutics (Boston, MA)
- …a thorough understanding of operating infrastructure of Strategic Business Unit(s) (SBUs) operations to be able to proactively analyze and identify opportunities for ... 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
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …Clinical Reimbursement Specialist will work under the direction of the Corporate Director of Clinical Operations - MA division. The Clinical Reimbursement ... responsibility. Ensures compliance with federal and state regulations, MA Medicaid, Medicare and Managed Care payment systems. Monitors, consults, and makes… more
- Commonwealth Care Alliance (Boston, MA)
- …to Us:** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, the Payment Integrity (PI) Recovery Analyst ... Experience (must have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication,… more