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Compliance and Regulatory Oversight: In collaboration with organizational risk management and compliance leadership, ensures compliance with all federal, state, and local regulations governing FQHC operations, including HRSA, DPH, CMS, HIPAA, and NCQA PCMH requirements and standards.
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Strategic Planning: Collaborates with the executive team to develop and implement strategic initiatives that support the mission, vision, and goals of the FQHCs; identifies and executes growth opportunities, partnerships, and innovative payment and service delivery models and participates in the development and implementation of Harbor Health ACO strategies, assuring operation compliance with the ACO contract requirements and collaboration with ACO partners.
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Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
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Manage the ongoing implementation of the IE&E Noticing Solution for MH/Non-MAGI (MA21) in FY24 and implementations for MH/MMIS member notices and DTA Non-BDN in FY25/26. Proven ability to work with Legislative Staff, Federal organizations (Center for Medicaid and Medicare (CMS), and Food and Nutrition Service (FNS), Providers, and Advocate Organizations, and Commonwealth's Human Resources Division (HRD) and Collective Bargaining Organizations, on program/project goals, status, etc.
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The Infection Preventionist for Massachusetts General Hospital (MGH) is responsible for the day-to-day implementation of the Infection Prevention functions of MGH IC, one of the site teams of MGB Infection Control.
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Coordinate with Finance leadership and Director Regulatory & Statutory Accounting in compliance with CMS and State regulatory requirements. Assist with the design and implementation of accounting policies and procedures in accordance with US GAAPEnsure timely and accurate month-end and year-end accounting closings and financial reporting to multiple internal and external Departments.
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Extensive experience interacting with regulatory and accreditation authorities and a demonstrated history of successfully responding to investigations/inquiries from the Office for Civil Rights, Joint Commission, URAC/NCQA, MA state agencies and CMS among others.
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The Infection Preventionist for Spaulding Rehabilitation Hospital (SRH) sites is responsible for the day-to-day implementation of the Infection Prevention functions of SRH IC, one of the site teams of MGB Infection Control.
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The Revenue Integrity Analyst is responsible for assisting in the implementation of new revenue capture procedure records within the hospital chargemaster (CDM) and the development of workflows to ensure timely and accurate capture of all Lahey Health System revenue.
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Reporting directly to the Director of Strategic Implementation and working closely with other members of the marketing and Medicare Advantage teams, the Content Specialist, Medicare Advantage leads efforts to create interest in and excitement for our Medicare Advantage products and to attract and retain customers.
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Familiar with CMS and digital asset management systems. You'll own the website strategy and its implementation applying your strategic thinking, technical knowledge, UX design/content skills, and extensive execution experience to deliver a world-class web experience that evolves to meet the needs of Tulip and our customers.
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This position is part of the Enterprise HEDIS Implementation Team. It will be responsible for working with management and peers on data ingestion, mapping, transformation, and reporting to support NCQA/CMS and State Medicaid agencies.
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Directs the development and implementation ofhigh quality, sustainable, educational program for nurses and medical assistants that aligns with EBNHC’s strategic initiatives, National Patient Safety Goals and Joint Commission standards.
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This requires a passion for Digital Marketing, expertise in the Adobe ecosystem or CMS Headless experience with React, and the experience to guide web development teams, both internal and third parties.
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Monitors sites and regulation governing healthcare transaction data to include AMA, CMS, NUBC, UB Editor, WPC DHHS, EOHHS, and, listservs and other sources to identify existing coding & payment practice and upcoming changes.
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