• 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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  • Medical Director - Dsnp /MMP

    CVS Health (Tallahassee, FL)
    …oversight of DSNP /MMP complex populations (Dual-Eligible Special Needs Plan / Medicare- Medicaid Plan) * Develop and lead clinical strategy and objectives for ... delivery system, utilization management, reimbursement methods and treatment protocols for DSNP /MMP and other complex health populations to optimize risk adjustment,… more
    CVS Health (10/15/25)
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  • VP, Medicaid Regional President

    Humana (Indianapolis, IN)
    …Special Needs Plans ( DSNP ), which serve members who qualify for both Medicare and Medicaid . They will lead the state Medicaid executive team and report ... part of our caring community and help us put health first** The VP, Medicaid Regional President (CEO) for Indiana will be responsible for the overall strategic… more
    Humana (10/21/25)
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  • Encounter Data Management Lead

    Humana (Frankfort, KY)
    …a part of our caring community and help us put health first** The DSNP Encounters Data Management Lead supports the Encounter Data Management team within ... (HQRI). This support includes submission of encounter data to Medicaid , Medicare, and DSNP states and will...analyze new regulatory requirements, and support the development of compliance and operational processes. The Lead , Encounter… more
    Humana (10/29/25)
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  • Value Based Programs Business Intelligence…

    Humana (Albany, NY)
    …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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  • Senior Compliance Analyst, Duals (D-SNP)

    Centene Corporation (Austin, TX)
    … with Duals (D-SNP) Program requirements. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement ... its Duals and SMAC regulatory filings. + Manages Duals (and Medicare with D- DSNP specific or separate) compliance reporting responsibilities and respond to… more
    Centene Corporation (10/23/25)
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  • Care Management Coordinator

    CVS Health (Columbia, SC)
    …and every day. **Program Summary** Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible populations! You will have ... life-changing impact on our Dual Eligible Special Needs Plan ( DSNP ) members, who are enrolled in both Medicare and...) members, who are enrolled in both Medicare and Medicaid . As a member of the care team, you… more
    CVS Health (11/14/25)
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