- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Humana (Boston, MA)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...are involved in Board and other administrative meetings. Fellows report directly to Joel Port, SVP, Business and Network… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... in the development, accumulation and evaluation of key elements necessary to properly report the financial position of the organization. The FARL is responsible to… more
- CenterWell (Boston, MA)
- …evaluating and operationalizing high-impact complex care initiatives to drive quality and cost improvement for high-risk senior populations in full risk Medicare ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Amazon (Boston, MA)
- …One Medical. We are looking for leaders that have healthcare experience in Medicare or other government funded health insurance to support our internal and external ... on FP&A workstreams. Key job responsibilities - Ownership of monthly Medicare membership models and reporting, including gathering, manipulating, analyzing, and… more
- Humana (Boston, MA)
- …Associate Actuary, Medicaid Trend focuses on developing, monitoring, and communicating cost trend drivers, utilization patterns, and economic insights to support ... you will play a critical role in identifying, quantifying, and explaining healthcare cost and utilization trends. The Associate Actuary works together with a team of… more
- Molina Healthcare (Worcester, MA)
- …progress toward desired outcomes with quality care that is medically appropriate and cost -effective based on the severity of illness and the site of service. ... and/or member assessment. + Typically, through one or more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with… more
- Elara Caring (Chicopee, MA)
- …+ Experience with Medicare and Medicaid guidelines are preferred You will report to the Clinical Manager. \#LI-EF1 _This is not a comprehensive list of all ... full-time staff and continuing education opportunities for all employees at no cost + Opportunities for advancement + Comprehensive insurance plans for medical,… more
- Baystate Health (Springfield, MA)
- …MA **THE ADVANTAGES OF WORKING WITH BAYSTATE!** + Excellent Compensation High-quality, low- cost medical, dental and vision insurance + Generous PTO - up to ... participation, develop unit time schedules, etc. **4)** Communication: provides report /handoff to next shift including pending discharges, admissions in process,… more
- Elara Caring (Boston, MA)
- …of experience in fast-paced office is preferred + Working knowledge of Medicare /Medicaid, home care benefits, and applicable state policies and procedures preferred ... patient care + Reliable transportation to perform job responsibilities You will report to the Coordination Team Lead, Branch Director, or Alternate Branch… more