- Commonwealth Care Alliance (Boston, MA)
- …against internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. - Lead initiatives to ... operations , education, and performance improvement. The Provider Relations Director reports to the Sr Director of... and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations , including regulatory and… more
- Commonwealth Care Alliance (Boston, MA)
- …cross-functional projects and meeting deadlines. + Strong understanding of Medicare, Medicaid , duals program, and health plan operations , including regulatory ... foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... on CCA's Population Health goals; including Medicare Star measures, Medicaid -Medicare Plan withhold measures, quality performance metrics incorporated into other… more
- Commonwealth Care Alliance (Boston, MA)
- …in alignment with clinical licensure. - Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations , including regulatory and ... quality care. The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement. Supervision Exercised: - No,… more
- Commonwealth Care Alliance (Boston, MA)
- …satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will: + ... subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience with… more
- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for timely review and… more
- CVS Health (Boston, MA)
- …given to candidates residing in the eastern time zone._ **Position Summary** The Lead Director of Product Operations will assume full ownership of Mental Well ... and strategic alignment across the MWB portfolio. The Lead Director will lead post-implementation monitoring, drive cross-functional issue resolution, and… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and… more
- Commonwealth Care Alliance (Boston, MA)
- …against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. * Lead initiatives to ... operations , education, and performance improvement. The Provider Relations Director reports to the Sr Director of... and satisfaction. * Strong understanding of Medicare and Medicaid health plan operations , including regulatory and… more
- Option Care Health (Boston, MA)
- …Sales Director will work collaboratively with Option Care Health Operations to resolve customer service issues and ensure high-quality service and ongoing ... talent in healthcare. **Job Description Summary:** The Specialty Sales Director will develop and implement the Specialty business sales...Insurance, Medicare Part B & D, Fee for Service Medicaid , Managed Medicaid ) Due to state… more
