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US Browse · Canton Ma · Other - Healthcare

Other - Healthcare in Canton Ma

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Director, Individual Markets Engagement & Operations
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $164,034.40 - $246,051.60; bonus/equity: var...
**
10-15 years professional experience
Aca health plan product management
Federal and state exchange operations
The Director is responsible for the overall success of Point32Health's Individual Markets sales, products, and operations serving over 200,000 members across three states
39 days ago
Dual Eligible Markets Performance Manager, Product Strategy (p&l Manager)
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $94,363.70 - $141,545.54; bonus/equity: vari...
Fully remote
+5y experience
5 years medicare advantage or medicaid managed care experience
Strong analytical and strategic thinking skills
Proficiency in data analysis tools and microsoft office suite
The role supports product strategy design and end-to-end performance management for Point32Health's dual eligible products serving over and under 65 members
39 days ago
Director, Product Data Management And Operations
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $151,078.40 - $226,617.60; bonus/equity: var...
Fully remote
10-15 years relevant experience
Bachelor's degree required
Lead large teams effectively
The role drives configuration strategy and execution for claim adjudication systems to ensure accurate setup of benefits and payment processes
39 days ago
Supervisor, Member Services
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $63,955.04 - $95,932.56; bonus/equity: varia...
Fully remote
+5y experience
3-5 years customer service experience
Knowledge of medical terminology
Hipaa compliance adherence
The Supervisor is responsible for the direct supervision of Member Services colleagues including Advocates and Team Leaders while maintaining up-to-date knowledge of Point32Health products
39 days ago
Appeals And Grievance Analyst
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $23.02 - $34.53 ph; bonus/equity: variable p...
**
Mid-level
2-4 years customer service experience
Knowledge of ncqa, doi, cms, dol regulations
Ability to work under tight regulatory timelines
The role involves managing member appeals and grievances while ensuring strict compliance with NCQA, DOI, CMS, and DOL regulations
39 days ago
Um Specialist
Harvard Pilgrim Health Care Inc
Canton, MA, US
Full time
Base: $24.03 - $36.05; bonus/equity: variable pyy ...
**
+3y experience
3+ years managed care experience
Medical necessity denial letters
Staff audits and monitoring tools
The UM Specialist is responsible for the daily management of non-clinical reviews supporting the clinical and business work of the Utilization Management department
41 days ago
Supervisor, Member Services - Public Plans
Harvard Pilgrim Health Care Inc
Canton, MA, US
Full time
Base: $63,969.29 - $95,953.93; bonus/equity: varia...
Fully remote
+5y experience
3-5 years customer service experience
Knowledge of medical terminology
Hipaa compliance adherence
The Supervisor is responsible for the direct supervision of Member Services colleagues including Advocates and Team Leaders while maintaining up-to-date knowledge of Point32Health products
41 days ago
Senior Contract Manager Ancillary Network Contracting
Point32health Inc
Canton, MA, United States
Base: $103,034.92 - $154,552.38; bonus/equity: var...
**
Senior
Ancillary network contracting
Provider contract negotiation
Reimbursement strategy adherence
The Senior Contract Manager will manage complex ancillary specialties for Harvard Pilgrim and Tufts Health networks across all lines of business
58 days ago
Appeals & Grievances Coordinator-1
Point32health Inc
Canton, MA, United States
$20.98 - $31.46 ph
On-site
+2y experience
Excellent organizational skills
Knowledge of basic medical terminology
Ability to manage multiple priorities
Point32Health is dedicated to delivering high-quality, affordable healthcare
58 days ago
Member Service Advocate-1
Point32health Inc
Canton, MA, United States
Base: $21.00; bonus/equity: not specified; benefit...
**
+2y experience
Handle inbound calls
Resolve member inquiries
Navigate healthcare system
The Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, dressing inquiries, resolving issues and ensuring members have a positive experience with Point 32 Health
58 days ago
Vice President, Medical Management
Point32health Inc
Canton, MA, United States
Base: $240,000.00 - $290,000.00; bonus/equity: not...
On-site
Lead medical management strategy
Transform in-patient, ambulatory, post-acute settings
Develop multi-year strategy
The Vice President of Medical Management is responsible for leading and transforming the medical management of in-patient, ambulatory and post-acute settings
58 days ago
Clinical Reviewer, Behavioral Health
Point32health Inc
Canton, MA, United States
Base: $76,118.26 - $114,177.38; bonus/equity: not ...
On-site
Adherence to review guidelines and criteria
Prioritization of authorization requests
Concurrent review of services
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
58 days ago
Sco Community Health Worker(bilingual Spanish)
Point32health Inc
Canton, MA, United States
Base: $59,769.66 - $89,654.48; bonus/equity: not s...
On-site
+5y experience
Social determinants of health assessments
Culturally appropriate health education
Advocate for member needs
The Community Health Worker (CHW) assists members in managing their health goals in the community, working collaboratively to increase member knowledge, motivation, and adherence to key components of their health care
58 days ago
Director, Inpatient Um
Point32health Inc
Canton, MA, United States
Base: $166,666.40 - $249,999.60; bonus/equity: not...
**
Utilization management review
Medical management activities
Regulatory compliance
The Director, Inpatient Utilization Management is responsible for directing, leading, and modifying the business processes and operations for utilization management (UM) review
58 days ago
Clinical Reviewer, Bh Outpatient Services
Point32health Inc
Canton, MA, United States
Base: $81,217.85 - $121,826.77; bonus/equity: not ...
On-site
+3y experience
Adherence to review guidelines and criteria
Prioritization of authorization requests
Concurrent review of services
The Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise contract requirements
58 days ago
Sr. Provider Audit Analyst
Point32health Inc
Canton, MA, United States
Base: $80,607.48 - $120,911.22; bonus/equity: not ...
**
Mid-level
Claims data analysis
Cpt, hcpcs, icd10-cm codes
Data mining and analytics
The Provider Audit Analyst audits claims for coding accuracy, benefit, payment and contract interpretation in accordance to claims processing guidelines, HPHC Medical and Payment Policies and established audit protocol
58 days ago
Manager, Behavioral Health (outpatient) Um & Programs
Point32health Inc
Canton, MA, United States
Base: $98,659.20 - $147,988.80; bonus/equity: not ...
On-site
+5y experience
Behavioral health utilization management
Clinical process management
Team performance management
The Manager, Behavioral Health is responsible for leading at least one Behavioral Health functional team, managing team performance and results, and for managing the clinical processes that support the Behavioral Health department
58 days ago
Clinical Pharmacist
Point32health Inc
Canton, MA, United States
Base: $110,594.35 - $165,891.53; bonus/equity: not...
On-site
Prior authorization review
Coverage determinations
Consult with medical directors
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
58 days ago
Sco Community Health Worker(bilingual Spanish)
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $59,769.66 - $89,654.48; bonus/equity: varia...
Fully remote
+5y experience
Social determinants of health assessments
Culturally appropriate health education
Advocate for basic needs
The Community Health Worker will engage in regular telephonic and in-person member assessments pertaining to Social Determinants of Health (SDoH), visits at regularly scheduled intervals, and will conduct urgent visits to ensure that a members' Plan of Care is fully comprehensive and addresses significant medical, behavioral, and social needs
65 days ago
Member Service Advocate, Public Plans-18
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $22.00; bonus/equity: not specified; benefit...
Fully remote
+2y experience
Inbound call management
Health care system navigation
Problem resolution
The Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, addressing inquiries, resolving issues and ensuring members have a positive experience with Point 32 Health
65 days ago
Member Service Advocate-1
Harvard Pilgrim Health Care Inc
Canton, MA, United States
Full time
Base: $21.00; bonus/equity: not specified; benefit...
Fully remote
+2y experience
Handle inbound calls
Resolve member inquiries
Navigate healthcare system
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
65 days ago
Staff Pharmacist Part Time
CVS Health
Canton, MA, United States
Part time
Base: $60.00 - $76.00; bonus/equity: not specified...
Senior
Active pharmacist license
Patient safety compliance
Pharmacy team leadership
At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work
78 days ago

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Other - Healthcare in Canton Ma

Director, Individual Markets Engagement & Operations

Dual Eligible Markets Performance Manager, Product Strategy (p&l Manager)

Director, Product Data Management And Operations

Supervisor, Member Services

Appeals And Grievance Analyst

Um Specialist

Supervisor, Member Services - Public Plans

Senior Contract Manager Ancillary Network Contracting

Appeals & Grievances Coordinator-1

Member Service Advocate-1

Vice President, Medical Management

Clinical Reviewer, Behavioral Health

Sco Community Health Worker(bilingual Spanish)

Director, Inpatient Um

Clinical Reviewer, Bh Outpatient Services

Sr. Provider Audit Analyst

Manager, Behavioral Health (outpatient) Um & Programs

Clinical Pharmacist

Sco Community Health Worker(bilingual Spanish)

Member Service Advocate, Public Plans-18

Member Service Advocate-1

Staff Pharmacist Part Time