- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as ... escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- Bristol Myers Squibb (Boston, MA)
- …. Reporting into the Medical Value Liaison Field Director, the Senior Medical Value Liaison (MVL)/Executive MVL is a field-based role focused ... on applying clinical expertise and experience/knowledge of payors, health policy, payer...policy makers, and other decision makers and influencers. **Responsibilities** ** Senior Medical Value Liaison** + Provide comprehensive, accurate, fair,… more
- Beth Israel Lahey Health (Boston, MA)
- …of America) Under the general direction of the Associate Director of the Clinical Trials Office (CTO), the Senior Contracting Specialist works with ... clinical research. + Understands and keeps current with FDA and Medicare regulations applicable to clinical trials. Implements rules, regulations, guidelines… more
- Highmark Health (Boston, MA)
- …efficiencies. + Manage individual projects for timely review with the Director, Clinical Pharmacy. + Participate in Medicare Stars performance measures to ... health coaching. If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests;...products, and database applications + Pharmacy license **Preferred** + Medicare knowledge + Prioritization skills + Knowledge of Excel… more
- Humana (Boston, MA)
- …facilitate optimal care and treatment, when necessary, to educate and address clinical necessity concerns and ACD policy compliance requirements. + Facilitating ... This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care Demonstration (ACD) defined… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Senior Product Owner will review documentation and provide feedback on quality and accuracy related to the product portfolio ... new technology opportunities to attain operational efficiencies and growth opportunities. The Senior PO will lead a portfolio of projects and enhancements, and build… 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
- 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
- Commonwealth Care Alliance (Boston, MA)
- …and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment, HCC, clinical and coding reviews; DRG and ... reviews and assessments that address a combination of financial, operational, governance/ compliance , clinical and technology/systems objectives. + Experience in… 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
- Commonwealth Care Alliance (Boston, MA)
- …stakeholders + Keeps current with emerging trends in hospital quality, safety, and clinical compliance , and integrates key concepts into daily operations. + ... to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid- Medicare Plan withhold measures, quality performance… more
- State of Massachusetts (Tewksbury, MA)
- …and security measures across the hospital campus. Partnering closely with senior leadership and department supervisors, you will be integral in maintaining ... compliance with accreditation and regulatory standards while upholding the...as The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). Your expertise will be… more
- Humana (Boston, MA)
- …reporting the members health status, as well as inclusion in the appropriate clinical programs. The Health Quality and Stars team centralizes quality improvement and ... governance processes targeting Humana's Medicare Advantage members while also managing compliant data submissions...of action. + Lead and develop a team of senior professionals + Manage provider inventory for the program… more
- State of Massachusetts (Boston, MA)
- …Registered Nurse. The CQO is accountable to lead, support and guide the Senior Leadership team in matters related to regulatory requirements, quality, and patient ... including oversight of Joint Commission Survey Readiness, Performance Improvement, Clinical Quality, Quality Data Management, Patient Advocacy and HIPAA Privacy.… more