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The Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state funds, and 2) enabling the operational effectiveness of Program Integrity across all its sub-teams.
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Lead program integrity oversight of managed care entities’ controls against fraud, waste and abuse, including identification and implementation of best practices, reporting compliance, claims data analysis, development of key performance indicators, and interface directly with MassHealth’s managed care entities.
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Establish and develop new partnerships, linkages, and program collaborations with other city agencies and BPHC programs, service providers health care providers, managed care organizations, volunteer and non-profit organizations, advocacy groups, and consumer groups.
$110,000 - $120,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities.
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Refer elders to other programs when appropriate, which may include Medicaid Waiver, Respite, Managed Care, Supportive Housing, or other relevant resources. The Geriatric Care Manager is assigned to work with consumers enrolled in the Senior Care Option (SCO) Program and/or State Home Care Program.
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Strong knowledge of and/or experience with government programs regulatory, operational, financial, and clinical requirements for the delivery of health insurance and managed care products and services, including Medicare, Medicaid, MMP, LTSS, SNP, Duals, CHIP, and behavioral health, as well as the associated and relevant federal, state, and local regulatory entities.
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The Housing Support Specialist provides specialized housing services to individuals enrolled with the Behavioral Health Community Partner (BHCP) program or with an Accountable Care Organization (ACO) or Managed Care Organization (MCO) plan.
$50,000 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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He/she will oversee all clinical functions that support his/her respective unit(s) such as managed care coordination, scheduling, medical records, charge capture, etc. Works closely to uphold the Ambulatory Care Transformation (ACT) work that ensures all patients are scheduled appropriately.
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This person should be familiar with and able to discuss different segments of market access, contracting strategies and tactics, understand the various types of managed care contracting and be able to determine the potential value of a contracting opportunity.
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Experience should include strong understanding of Managed Care, Medicare Part B, GPO, PBM and other Payer segments. Understanding of key Payer and customer segments relevant to brand products and the US Reimbursement System across major Payer segments (Managed Care, Medicare, Medicaid, Federal.
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The HHA/CNA will work as part of a self-managed team directly responsible for providing high quality care to our hospice clients in the Greater Boston area while being a constant companion striving to protect, nurture and sustain the client in a competent, caring and kind manner.
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The PBR will have a strong working knowledge of all aspects of the billing/revenue cycle, managed care requirements, coding and compliance. Investigates managed care related issues with the payer and the Patient Service Center.
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The CareBridge Long Term Services and Supports (LTSS) Clinical Assessor collaborates with Managed Care Organizations (MCOs) to support persons receiving home and community-based services.
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As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
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Medical, dental & vision: Prismatic offers high-quality medical (Wellmark Blue Cross and Blue Shield), dental (Delta Dental), and vision (VSP) care for full-time employees and their dependents.
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managed care jobs in Boston, MA
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