- Elevance Health (Woburn, MA)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
- Tufts Medicine (Burlington, MA)
- …throughout the greater Boston region. **What you will do:** Our new Director Regional Operations for Tufts Medicine Integrated Network (TMIN) reporting ... 1. Serves as a key member of the strategic operations team, works collaboratively and provides critical input into...12. Serves as a liaison to various payers including Medicare Shared Savings Program (MSSP), Medicare Advantage… 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
- Conviva (Boston, MA)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Molina Healthcare (Boston, MA)
- …and must live in Massachusetts _** **Job Description** **Job Summary** The Director , LTSS Partnerships plays a critical role in the development and implementation ... financial, clinical, quality, member satisfaction, compliance, and growth goals. The Director will be working within a highly matrixed organization focused on… more
- Gilead Sciences, Inc. (Boston, MA)
- …the lives of patients with life-threatening illnesses worldwide. As the **Senior Director , Field Reimbursement Management (FRM)** for HIV Prevention, you will play a ... This position will drive the Field Reimbursement team's strategic direction, operations , and performance to optimize patient access and navigate complex insurance… 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
- 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
- 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
- Beth Israel Lahey Health (Charlestown, MA)
- …Management, Customer Service, Cash Posting, Denial Management, and overall Revenue Cycle operations . Assists Director with system wide policies, objectives, and ... you're making a difference in people's lives.** Under oversight of the Director , the Manager, BILH Patient Financial Services Hospital Billing is responsible for… more
- Prime Therapeutics (Boston, MA)
- …the organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory guidance + Develop ... and regulatory issues that impact Prime's compliance programs or business operations ; document requirements or disciplinary actions and escalate findings as… more
- Prime Therapeutics (Boston, MA)
- …and ability to adjust focus **Reporting Structure** + Reports to a manager or director in the Clinical Operations , Contact Center, Network Management or PBM ... processes, and participates in committee review meetings within the Commercial, Medicare , Medicaid, and Health Insurance Marketplace for the assigned department.… more
- Bristol Myers Squibb (Boston, MA)
- …within the assigned territory. The CMAM will report into the East Region Director , Cell Therapy Market Access Managers. The individual is required to achieve all ... Therapy Account Management Team, Payer Account Executives, Cell Therapy Patient Operations , Cell Therapy Patient Support Services, Cell Therapy Access Strategy Team,… more
- Prime Therapeutics (Boston, MA)
- …in assigned function to ensure organizational obligations are met and business operations are aligned with applicable laws and regulatory guidance. + Provide ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...ability to adjust focus **Reporting Structure** + Reports a Director in the Compliance department Potential pay for this… more
- Tufts Medicine (Lawrence, MA)
- …+ Communicates regularly with Clinical Managers as well as with the Clinical Director when issues arise relative to clinical practice or other performance related ... working knowledge of all regulations;Has a working knowledge of the Medicare Conditions of Participation; and Assisting with individual caseload reviews or… more
- Prime Therapeutics (Boston, MA)
- …to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance + Lead ... or PBM organization, or other highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Commonwealth Care Alliance (Boston, MA)
- …and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid contractual and regulatory requirements. ... Role is Important to Us:** Under direction of the Director of Internal Audit, the primary functions of this...to the Continuous Compliance Risk Assessment process. + Alert Director of Internal Audit of identified new or emerging… more
- Spaulding Rehabilitation (Charlestown, MA)
- …medical record documentation for the purposes of ensuring compliance with Medicare , Medicaid (CMS) regulations and guidelines and to expedite appropriate ... new hire orientation. **Key Responsibilities** + Partners with CDI Medical Director to educate physicians and key healthcare providers regarding clinical… more
- Public Consulting Group (Boston, MA)
- …Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies ... support the public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of fire/emergency medical services… more
- Commonwealth Care Alliance (Boston, MA)
- …and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare and Medicaid contractual and regulatory requirements. ... **Why This Role is Important to Us:** **Position Summary:** Under direction of the Director of Internal Audit, the primary functions of this position are to: +… more