Displaying 1 - 15 of 42 Jobs.
Product Benefit Administration Specialist
Boston, MA
The Product Benefit Administration Specialist is responsible for day to day benefit/product administration operations, ensuring the alignment of business processes and decisions with the...
Boston, MA
The Product Benefit Administration Specialist is responsible for day to day benefit/product administration operations, ensuring the alignment of business processes and decisions with the...
Utilization Management Special Projects Manager
Boston, MA
The Utilization Management (UM) Special Projects Manager is responsible for efficiently managing major department projects and programs with cross functional impact and significant compl...
Boston, MA
The Utilization Management (UM) Special Projects Manager is responsible for efficiently managing major department projects and programs with cross functional impact and significant compl...
Senior Director, Network Operations Strategy
Boston, MA
Reporting to the SVP Network Management & Operations, the Senior Director, Network Operations Strategy is responsible for the development of the enterprise Network Operations Strategy fu...
Boston, MA
Reporting to the SVP Network Management & Operations, the Senior Director, Network Operations Strategy is responsible for the development of the enterprise Network Operations Strategy fu...
Program Coordinator, Special Kids Special Care
Boston, MA
The Program Coordinator works with relevant stakeholders to support the administration of the Special Kids Special Care program. The individual is responsible for working with the SKSC c...
Boston, MA
The Program Coordinator works with relevant stakeholders to support the administration of the Special Kids Special Care program. The individual is responsible for working with the SKSC c...
Appeals and Grievance Specialist
Boston, MA
The Appeals and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member generated complaints/grievances, and ensuring...
Boston, MA
The Appeals and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member generated complaints/grievances, and ensuring...
Manager of Application Services & Support
Boston, MA
The Manager of Application Services and Support leads a team in the delivery of technology support services to internal users of WellSense business applications. This includes WellSense...
Boston, MA
The Manager of Application Services and Support leads a team in the delivery of technology support services to internal users of WellSense business applications. This includes WellSense...
Director of Financial Planning and Analysis
Boston, MA
Directs financial planning and associated analysis activities at a leading health plan with a large market share of Medicaid lives in Massachusetts and New Hampshire, as well as Commerci...
Boston, MA
Directs financial planning and associated analysis activities at a leading health plan with a large market share of Medicaid lives in Massachusetts and New Hampshire, as well as Commerci...
Prior Authorization Medical Clinician
Boston, MA
Evaluates and approves requested services using organizational policies or InterQual screening criteria. Manages appropriate cases that require medical necessity review such as home care...
Boston, MA
Evaluates and approves requested services using organizational policies or InterQual screening criteria. Manages appropriate cases that require medical necessity review such as home care...
Director of Operations Utilization Management
Boston, MA
T he Director of Utilization Management (UM) Operations i s ac c o u n t a b l e f or developing and maintaining the framework to achieve efficient and effective operational processes, p...
Boston, MA
T he Director of Utilization Management (UM) Operations i s ac c o u n t a b l e f or developing and maintaining the framework to achieve efficient and effective operational processes, p...
UM Operations Program Manager
Boston, MA
The UM Operations Program Manager is responsible for managing department systems changes, testing and implementation across all teams. Evaluates end to end processes supported through sy...
Boston, MA
The UM Operations Program Manager is responsible for managing department systems changes, testing and implementation across all teams. Evaluates end to end processes supported through sy...
Coder-Risk Adjustment
Boston, MA
The Coder manages the day to day responsibilities of chart abstraction and reporting in accordance with state and federal regulations. The coder will abstract from inpatient and outpatie...
Boston, MA
The Coder manages the day to day responsibilities of chart abstraction and reporting in accordance with state and federal regulations. The coder will abstract from inpatient and outpatie...
Utilization Management Business Analyst
Boston, MA
Reporting to the Director of Operations, Utilization Management, the Medical Management Program Analyst (MMPA) plays a key role in the implementation of new medical management systems, t...
Boston, MA
Reporting to the Director of Operations, Utilization Management, the Medical Management Program Analyst (MMPA) plays a key role in the implementation of new medical management systems, t...
Care Coordinator, BH
Boston, MA
The Care Coordinator, BH is a member of the Behavioral Health Care Management (BH CM) team whose role is to perform telephonic outreach and screenings of identified members and to provid...
Boston, MA
The Care Coordinator, BH is a member of the Behavioral Health Care Management (BH CM) team whose role is to perform telephonic outreach and screenings of identified members and to provid...
Director of Accreditation
Boston, MA
The Director of Accreditation is responsible to attain and maintain NCQA Health Plan Accreditation and NCQA Health Equity Accreditation. The Director oversees the accreditation and clini...
Boston, MA
The Director of Accreditation is responsible to attain and maintain NCQA Health Plan Accreditation and NCQA Health Equity Accreditation. The Director oversees the accreditation and clini...
Learning and Development Technical Writer
Boston, MA
The Technical Writer is responsible for organizing, editing, and maintaining internal procedural content, including knowledge articles, job aids, FAQs, and additional materials from vari...
Boston, MA
The Technical Writer is responsible for organizing, editing, and maintaining internal procedural content, including knowledge articles, job aids, FAQs, and additional materials from vari...