Neighborhood Health Plan Jobs in Massachusetts

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24 Neighborhood Health Plan jobs in Massachusetts found on Monster.

Jobs 1 to 20 of 24
Primary Responsibilities: Preparation of various regulatory filings to the Division of Insurance, MassHealth and the Health Connector Responsible for all journal entries and transactions for assigned accounts Responsible for monthly account reconciliations for assigned accounts including resolution of variances Assist in the review of monthly financial statements Assist in the preparation of ...
Primary Responsibilities: Provide primary care, care management and overall coordination of the plan of care to children with disabilities in collaboration with primary care physicians and specialty providers. Work closely with families, foster parents, social workers from DCF, community service providers and schools to provide comprehensive care that supports the child and the family and maximi...
Primary Responsibilities: Act as a customer advocate in providing assistance to resolve customer’s issues and problems. Responds to calls from members, employers and Brokers, regarding benefits, policies, procedures and protocols. Work with internal departments as necessary to resolve member issues. Ensures that rate renewal and contract addendum process is completed in a timely manner.Coordinate...
Primary Responsibilities: Manages, supervises and coaches all assigned staff, ensuring a motivated, productive and customer-centric approach Manages project workflow process to ensure all creative deliverables are completed efficiently and on-time with accuracy Evaluates work and monitors quality control standards to ensure that all work meets the highest standards of accuracy, the appropriate ...
Primary Responsibilities: Handle a large volume of incoming grievances from receipt through resolution, ensuring that all grievances are resolved within contractual timeframes. Maintain a centralized tracking system to support reporting and analysis of member grievances. Record all documentation, research and notification letters related to grievances in NHP's call tracking database. Thoroughl...
Primary Responsibilities: Support the managed care transaction system configuration changes and new configuration requirements including configuration analysis, design, build and test. Configuration support to include, but not limited to, provider data management, provider contracts, benefit plans and employer groups Implement and improve operational efficiencies. Maximize QNXT capabilities Ana...
Primary Responsibilities: Under the guidance of the Manager of Business Analysis or Business Analyst, collaborates with key business partners to support business operations and understands how current and future systems enhancements may improve business processes and productivity. Elicits, gathers, creates and documents business requirements as part of the project lifecycle. Identifies, defines...
Primary Responsibilities: The Care Manager will assess, plan, implement, and evaluate care plans for NHP members. He/she will collaborate with social care managers, as well as behavioral health care managers, to develop a comprehensive approach to care coordination: Use of evaluative and outcomes data to improve ongoing care management services Promotion of health care outcomes in concert with ...
Primary Responsibilities: Responsibilities include conducting standardized assessments on all high-risk members including those identified through the Health Needs Assessment (HNA) process, enrollment and trigger reports, and other case identification sources, and establishing and implementing culturally competent care management plans to meet the needs of members. The CM will participate in qua...
Primary Responsibilities: Evaluates, negotiates and recommends necessary changes to existing ancillary provider contracts to ensure that targeted provider performance and financial goals are met. This includes detailed and on-going analysis of a provider’s ability to meet quality, performance and financial objectives. Negotiates contracts with new providers under the direction of the Manager of ...
Primary Responsibilities: Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures The Representative must ...
Primary Responsibilities: Participates in conducting readiness organizational self-assessments for NCQA accreditation by conducting chart reviews, reviewing documented procedures and providing guidance to relevant individuals. Assists in the preparation of the organization’s submission to NCQA by organizing, referencing and uploading supporting documents as required by the NCQA interactive surve...
Primary Responsibilities: Collaborate with key business partners such as: Claims Processing, Member Services, Member Enrollment, Clinical Operations, Provider Relations, Provider Audit, and Business Development Departments to support business operations and understand how current and future systems enhancements may improve business processes and productivity. Elicit, gather, create and document ...
Primary Responsibilities: Responsible for the development and maintenance of pricing source libraries, files, and fee schedules on a regular basis, using Medicare, Medicaid, NDC, and other pricing sources, in conjunction with actively monitoring both local and national industry regulations relating to fee schedules and adopted payment methodologies. Create reports and present written recommendat...
Primary Responsibilities: Evaluate, negotiate and recommend necessary changes to existing contracts to ensure that targeted provider performance and financial goals are met. Plays a kery role, as part of the team, working on and supporting special risk programs such as the Share Savings program as well as other risk programs. Identify medical cost improvement opportunities, the development of c...
Primary Responsibilities: Programming, including writing T-SQL in SQL Server and SSIS packages, which support the Vendor Interfaces. Analyze business and system requirements, including impact analyses on existing systems, to develop systems specifications In partnership with the business units, design, prepare and execute unit test plans for application upgrades and enhancements. General data ...
Primary Responsibilities: The successful candidate will have excellent staff management skills, written and verbal communication skills, as well as an understanding of utilization management and case management processes and clinical quality. Experience with Medicaid, project management, benefit & contract management, presentation development and compliance is preferred. A. Staff Management Eff...
Primary Responsibilities: Test Execution Assuming a leadership role for all aspects of testing within a project Coordinating test execution, including tasks, timeline and resource management between all impacted areas; systems, business analysts, business partners, and vendor. Directing, managing, planning and executing the testing activities for all appropriate projects. Preparing activity a...
Primary Responsibilities: Provide complimentary primary care, care management and overall coordination of the plan of care to individuals with disabilities and chronic illness in collaboration with primary care physicians and specialty providers. Collaborate with behavioral health specialists to ensure appropriate behavioral health care services. Work closely with families, community service pr...
Primary Responsibilities: Provide a consultative presence and value to the direct commercial sales team, developing a deep understanding of their line of business, product offerings and future needs to farm new opportunities. Develop marketing strategies and create marketing plans. Manage internal client relationships and engagement – serve as the primary day-to-day marketing contact and own th...

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