- CVS Health (Cumberland, RI)
- … managed care organization. In partnership with and under the direction of the Chief Medicaid Compliance Officer and Medicaid Compliance leadership team, ... other key department projects and initiatives to improve and enhance Aetna's Medicaid Compliance program, and serve as the compliance representative on… more
- Sumitomo Pharma (Boston, MA)
- …currently seeking a dynamic, highly motivated, and experienced individual for the position of ** Sr . Manager , Medicaid Contract Administration.** The Sr . ... , Medicaid Contract Administration is responsible for managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid … more
- Commonwealth Care Alliance (Boston, MA)
- …to regulators + Submit materials to regulators + Coordinate attestations from Senior Leadership for submission ** Compliance Regulatory Guidance Distribution** + ... more years direct work experience in regulatory affairs and/or compliance in Medicare or Medicaid required +...clearly inmeetings and to communicate with team members and senior leadership + Requires excellent interpersonal skills inorder to… more
- Commonwealth Care Alliance (Boston, MA)
- … (CHC) preferred + 5 or more years direct work experience inregulatory affairs and/or compliance in Medicare or Medicaid required + 5 or more years of managerial ... Role is Important to Us:** Under direction of the Sr . Director of Regulatory & External Audits, the primary...agencies including but limited to Centers for Medicare & Medicaid Services (CMS), Mass Health, Departments of Insurance, and… more
- Commonwealth Care Alliance (Boston, MA)
- …Program + Contribute towards the maintenance and enhancement of an effective Compliance Monitoring Program + Contribute towards the maintenance and enhancement of an ... effective Compliance Risk Assessment Program + Project manage regulator and...indicators **Additional Responsibilities** + Support Corrective Action Plan (CAP) Manager in communicating on new and existing CAPs emerging… more
- WellSense (Boston, MA)
- Senior Manager of Clinical UM - BH...Department on issues that have both legal risk and compliance aspects. + Partners with the Accreditation Manager ... and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical...our members, no matter their circumstances. **Job Summary:** The Senior Manager of Clinical Utilization Management (UM),… more
- Point32Health (Canton, MA)
- …education; and continuous process improvement activities. Report actual and potential risks for non- compliance to senior manager and lead mitigation planning ... Create an "audit ready" department culture. Collaborate with department Senior Manager & Team Managers, Corporate Compliance and other departments to… more
- Point32Health (Canton, MA)
- …Analytics and other members of the Network & Provider Analytics team, the Senior Manager will lead the analytic support of contract negotiations, strategic ... and mentoring to all members of the team. The Senior Manager will directly support complex analysis...adequacy across all lines of business in accordance with compliance and regulatory requirements. Additionally, will lead analysts in… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position** **Overview:** As a Senior Product Manager , within theclaimsvalue stream forHealthRulesPayor, you will have ownership of system ... **What** **You Bring** **: ** + 5+ years' experience as a product manager in a **SaaS-based, Agile** /Scrum technology company including all related processes (eg… more
- HealthEdge Software Inc (Boston, MA)
- **Overview** **Position Overview** **:** As aSenior Manager ,Product ManagementforHealthEdgeSource, you willbededicatedto developing innovative solutions for the ... and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for… more
- Commonwealth Care Alliance (Boston, MA)
- …the direction of the Sr . Director, TPA Management and Claims Compliance , Medical/BH Reimbursement Policy Manager will have overall responsibility for CCA's ... and Behavioral Health reimbursement policies for statewide impact. The Policy Manager is responsible for managing cross-departmental implementation of changes to… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of Trustee approved goals and regulatory and standard setting agencies. The Risk Manager performs as an internal compliance consultant by maintaining current ... The Risk Manager is a member of the Patient Safety...level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The… 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
- State of Massachusetts (Boston, MA)
- …is led by the Director of Program Integrity, who reports to the Deputy Medicaid Director, and consists of 10 internal staff members and dozens of contractors ($50M ... other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The position… more
- Brockton Hospital (West Bridgewater, MA)
- …of our patients. Position Summary: Under the general supervision of the Ambulatory Coding Manager , and the Senior Risk Coder, the primary function of this ... Provides training, problem solving and performance monitoring for associates. Works with Senior Risk Coder and Team members to perform Retrospective audits for… more
- Mathematica (Boston, MA)
- …opportunities in Commercial HCLS, including serving on proposal teams as a proposal manager . You will also work closely with Mathematica's corporate legal team as ... and opportunities in HCLS, including serving on proposal teams as proposal manager . * Develop budget specifications and review budget materials for proposals and… more
- Olympus Corporation of the Americas (Westborough, MA)
- …If your disability impairs your ability to email, you may call our HR Compliance Manager at 1-888-Olympus (###). Posting Notes: || United States (US) || ... health policy, including managed care organizations, IDN's, Medicare and Medicaid ; innovative reimbursement pathways, similar awareness of internal HTA agency… more