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Other - Healthcare in Canton Ma
Harvard Pilgrim Health Care Inc
Director, Individual Markets Engagement & Operations
10-15 years professional experienceAca health plan product managementFederal and state exchange operations$164,034.40 - $246,051.60 py
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
Canton, MA, USFull time+15y experienceJob Match ScoreCreate Profile
53 days agoHarvard Pilgrim Health Care Inc
Dual Eligible Markets Performance Manager, Product Strategy (p&l Manager)
5 years medicare advantage or medicaid managed care experienceStrong analytical and strategic thinking skillsProficiency in data analysis tools and microsoft office suite$94,363.70 - $141,545.54 py
The role supports product strategy design and end-to-end performance management for Point32Health's dual eligible products serving over and under 65 members
Canton, MA, USFully remoteFull time+5y experienceJob Match ScoreCreate Profile53 days agoHarvard Pilgrim Health Care Inc
Director, Product Data Management And Operations
10-15 years relevant experienceBachelor's degree requiredLead large teams effectively$151,078.40 - $226,617.60 py
The role drives configuration strategy and execution for claim adjudication systems to ensure accurate setup of benefits and payment processes
Canton, MA, USFully remoteFull time+15y experienceJob Match ScoreCreate Profile53 days agoHarvard Pilgrim Health Care Inc
Supervisor, Member Services
3-5 years customer service experienceKnowledge of medical terminologyHipaa compliance adherence$63,955.04 - $95,932.56 py
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
Canton, MA, USFully remoteFull time+5y experienceJob Match ScoreCreate Profile53 days agoHarvard Pilgrim Health Care Inc
Appeals And Grievance Analyst
2-4 years customer service experienceKnowledge of ncqa, doi, cms, dol regulationsAbility to work under tight regulatory timelines$23.02 - $34.53 ph
The role involves managing member appeals and grievances while ensuring strict compliance with NCQA, DOI, CMS, and DOL regulations
Canton, MA, USFull time+4y experienceJob Match ScoreCreate Profile53 days agoHarvard Pilgrim Health Care Inc
Um Specialist
3+ years managed care experienceMedical necessity denial lettersStaff audits and monitoring tools$24.03 - $36.05 ph
The UM Specialist is responsible for the daily management of non-clinical reviews supporting the clinical and business work of the Utilization Management department
Canton, MA, USFull time+3y experienceJob Match ScoreCreate Profile56 days agoHarvard Pilgrim Health Care Inc
Supervisor, Member Services - Public Plans
3-5 years customer service experienceKnowledge of medical terminologyHipaa compliance adherence$63,969.29 - $95,953.93 py
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
Canton, MA, USFully remoteFull time+5y experienceJob Match ScoreCreate Profile56 days agoPoint32health Inc
Senior Contract Manager Ancillary Network Contracting
Ancillary network contractingProvider contract negotiationReimbursement strategy adherence$103,034.92 - $154,552.38 py
The Senior Contract Manager will manage complex ancillary specialties for Harvard Pilgrim and Tufts Health networks across all lines of business
Canton, MA, USSeniorJob Match ScoreCreate Profile73 days agoPoint32health Inc
Appeals & Grievances Coordinator-1
Excellent organizational skillsKnowledge of basic medical terminologyAbility to manage multiple priorities$20.98 - $31.46 ph
Point32Health is dedicated to delivering high-quality, affordable healthcare
Canton, MA, USOn-site+2y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Member Service Advocate-1
Handle inbound callsResolve member inquiriesNavigate healthcare system$21.00 ph
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
Canton, MA, US+2y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Vice President, Medical Management
Lead medical management strategyTransform in-patient, ambulatory, post-acute settingsDevelop multi-year strategy$240,000.00 - $290,000.00 py
The Vice President of Medical Management is responsible for leading and transforming the medical management of in-patient, ambulatory and post-acute settings
Canton, MA, USOn-site+15y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Clinical Reviewer, Behavioral Health
Adherence to review guidelines and criteriaPrioritization of authorization requestsConcurrent review of services$76,118.26 - $114,177.38 py
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
Canton, MA, USOn-siteJob Match ScoreCreate Profile73 days agoPoint32health Inc
Sco Community Health Worker(bilingual Spanish)
Social determinants of health assessmentsCulturally appropriate health educationAdvocate for member needs$59,769.66 - $89,654.48 py
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
Canton, MA, USOn-site+5y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Director, Inpatient Um
Utilization management reviewMedical management activitiesRegulatory compliance$166,666.40 - $249,999.60 py
The Director, Inpatient Utilization Management is responsible for directing, leading, and modifying the business processes and operations for utilization management (UM) review
Canton, MA, US+10y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Clinical Reviewer, Bh Outpatient Services
Adherence to review guidelines and criteriaPrioritization of authorization requestsConcurrent review of services$81,217.85 - $121,826.77 py
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
Canton, MA, USOn-siteJob Match ScoreCreate Profile73 days agoPoint32health Inc
Sr. Provider Audit Analyst
Claims data analysisCpt, hcpcs, icd10-cm codesData mining and analytics$80,607.48 - $120,911.22 py
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
Canton, MA, US+7y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Manager, Behavioral Health (outpatient) Um & Programs
Behavioral health utilization managementClinical process managementTeam performance management$98,659.20 - $147,988.80 py
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
Canton, MA, USOn-site+5y experienceJob Match ScoreCreate Profile73 days agoPoint32health Inc
Clinical Pharmacist
Prior authorization reviewCoverage determinationsConsult with medical directors$110,594.35 - $165,891.53 py
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
Canton, MA, USOn-siteJob Match ScoreCreate Profile73 days agoHarvard Pilgrim Health Care Inc
Sco Community Health Worker(bilingual Spanish)
Social determinants of health assessmentsCulturally appropriate health educationAdvocate for basic needs$59,769.66 - $89,654.48 py
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
Canton, MA, USFully remoteFull time+5y experienceJob Match ScoreCreate Profile79 days agoHarvard Pilgrim Health Care Inc
Member Service Advocate, Public Plans-18
Inbound call managementHealth care system navigationProblem resolution$22.00 ph
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
Canton, MA, USFully remoteFull time+2y experienceJob Match ScoreCreate Profile79 days agoHarvard Pilgrim Health Care Inc
Member Service Advocate-1
Handle inbound callsResolve member inquiriesNavigate healthcare system$21.00 ph
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare
Canton, MA, USFully remoteFull time+2y experienceJob Match ScoreCreate Profile79 days agoCVS Health
Staff Pharmacist Part Time
Active pharmacist licensePatient safety compliancePharmacy team leadership$60.00 - $76.00 ph
At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work
Canton, MA, USPart time+2y experienceJob Match ScoreCreate Profile92 days ago
