- Public Consulting Group (Boston, MA)
- …and cultivate relationships with potential clients with a particular focus on state Medicaid agencies, children's behavioral health, child welfare and juvenile ... more, visit www.publicconsultinggroup.com . _Key responsibilities include:_ _Project Management_ + Lead the planning, execution, and monitoring of Medicaid … more
- Sumitomo Pharma (Marlborough, MA)
- …the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid claims and dispute resolution with state agencies. This position ... role with 2-3 days a week required in office. **Job Duties and Responsibilities** + Lead operations person for all Medicaid decisions as it relates to Model N… more
- Amazon (Boston, MA)
- …responsibilities include, but are not limited to: * Engage and build trusted partnerships with State Medicaid Agencies at the executive level (eg, State ... with technology transformation initiatives - Experience working in and with State Medicaid Agency leadership, influencing legislative priorities and CMS… more
- State of Massachusetts (Boston, MA)
- … state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor's Office, and Office of Inspector General. The position ... 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… more
- Takeda Pharmaceuticals (Boston, MA)
- …in the US, including but not limited to: Medicare national (Centers for Medicare & Medicaid Services [CMS]), Medicaid ( state and managed), Medicare Part B ... best. As the Head of US Oncology Patient Value and Access, you will lead a best-in-class organization that works proactively with Payers to underscore the value of… more
- HealthEdge Software Inc (Boston, MA)
- …(from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid , and commercial), payment integrity, and healthcare plan ... payment/policy configuration, provider relations, medical management, medical economics, audit, compliance ) related to implementation/consulting engagements, strategic user adoption initiatives,… more
- Humana (Boston, MA)
- …service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical ... Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in… more
- WellSense (Boston, MA)
- …materials + Participates in community outreach activities and events + Ensures quality and compliance with state Medicaid regulations and NCQA requirements + ... and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical...Health Plan ("Plan") and key provider organizations, taking the lead and promoting collaboration within Plan, as it relates… more
- WellSense (Boston, MA)
- …The Senior Manager will develop and implement policies and procedures that integrate state and federal regulations to ensure compliance with government agency ... and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical...and team performance, clinical program performance, team processes and compliance are essential. Working with his or her staff,… more
- Humana (Boston, MA)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **Use your skills to make an impact** **Required… more
- Commonwealth Care Alliance (Boston, MA)
- …The Senior Vice President, Internal Audit & Enterprise Risk Management (Remote) will lead the company's Internal Audit Program and activities as well as the ... organization and performing objective analyses of strategic, financial, operational, governance/ compliance , clinical, technological, internal controls, and risk management processes… more
- Humana (Boston, MA)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **This is a full-time work from home opportunity.… more
- Humana (Boston, MA)
- …meet authorization requirements. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... thinking and authorship. Exercises independence in meeting enterprise expectations and compliance timelines. Completes other duties as assigned. This is a full-time… more
- Humana (Boston, MA)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide… more
- Beth Israel Lahey Health (Charlestown, MA)
- …of both governmental and commercial payment systems. * Contributing Medicare, Medicaid , and payment system expertise to aid BILH's strategic and operational ... and reimbursement processes. This role demands meticulous attention to maintaining compliance and efficiency in all revenue-related operations within the system.… more
- CAI (Boston, MA)
- …responses and create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. **Job Description** **Job ... create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. This...will be **full-time** and **remote.** **What You'll Do** + Lead the review process for RFPs to determine suitability… 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...manage regulator and other external reviews as assigned** + Lead the coordination of external audits when noticed by… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …product designs, pricing, and benefits achieve market leadership + Lead and manage Medicare ancillary product strategy, diversification, innovation, development, ... and/or influence of product, marketing, sales, and operations business plans + Lead Medicare Integrated Medicare Market Team (IMMT) to support the development,… more
- Humana (Boston, MA)
- …necessity and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality standards. ... + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about...Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will… more
- HealthEdge Software Inc (Boston, MA)
- …**Your Impact** **: ** + Develop the product roadmap forclaimsvalue stream and lead high-level epic planning for current and futurequarters + Lead and ... and coordinate delivery of multiple product features across multiple engineeringteams + Lead engineering grooming sessions for selected epics and stories + Work… more