• Commonwealth Care Alliance (Boston, MA)
    …regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. - Lead initiatives to streamline provider ... provider operations and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance requirements.… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …components related to performance management activities as needed. - Lead the program's contributions to performance measurement logic, reporting rules, ... preferred. Required Experience (must have): - 5+ years - Experience with Medicaid and Medicare products and programs - Value-based program oversight and performance… more
    DirectEmployers Association (10/17/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged, ... also oversee corporate and business-as-usual (BAU) communications, support regulatory compliance , and champion digital innovation in provider engagement The Manager… more
    DirectEmployers Association (10/17/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …as a key liaison, proactively addressing provider needs, ensuring regulatory compliance , and supporting operational excellence to enhance provider satisfaction and ... Partnerships., the Senior Provider Relations Account Manager will: + Lead provider servicing activities, including onboarding, orientation presentations, and ongoing… more
    DirectEmployers Association (10/17/25)
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  • Value Based Programs Business Intelligence…

    Humana (Boston, MA)
    …manage multiple or competing priorities + Strong attention to detail + Experience in Medicaid , Medicaid managed care and/or DSNP + Experience with multiple ... Places to Work-as a Value Based Programs Business Intelligence Lead . In this impactful position, you will play a...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
    Humana (11/14/25)
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  • Director, Provider Relations

    Commonwealth Care Alliance (Boston, MA)
    …regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. * Lead initiatives to streamline provider ... provider operations and satisfaction. * Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance requirements.… more
    Commonwealth Care Alliance (10/18/25)
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  • Medical Director - Acute Rehab Team

    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 ... how to operationalize this knowledge in their daily work specifically for DSNP . The Medical Director's work includes computer-based review of moderately complex to… more
    Humana (11/07/25)
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  • Delegation Partnerships Performance Manager

    Commonwealth Care Alliance (Boston, MA)
    …components related to performance management activities as needed. * Lead the program's contributions to performance measurement logic, reporting rules, ... preferred. Required Experience (must have): * 5+ years * Experience with Medicaid and Medicare products and programs * Value-based program oversight and performance… more
    Commonwealth Care Alliance (10/18/25)
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