**** $5,000.00 Sign-On Bonus ****

About the role: As a RN Cinical Care Manager in the Clinical Services Team with eternalHealth, you will be a core member in the Clinical Services department at eternalHealth – whose responsibilities will include care management. You will work alongside a small team, reporting directly to the Head of Medical Management. This position will work towards meeting financial and operational performance goals and standards.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Collaborate on day-to-day clinical operations of the health plan, including complex care management, care coordination, disease management, and transition of care.
• Work on member- and provider-based interventions to improve quality and outcomes of care and reduce avoidable costs.
• Develop and refine clinically related compliance reporting and auditing activities.
• Work with a high performing team of clinical and non-clinical professionals that will deliver exceptional care while meeting quality and delivery targets.
• Follow eternalHealth’s strategic goals related to population health management and quality improvement, including setting and following the direction for analytics and existing quality measures.
• Interact regularly with executive team and department heads develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
• Ensures applicable Medicare (and any other LOB such as Mass Connector)requirements for clinical services activities and reporting are met.
• Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI) and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Requirements:

• Bachelor’s degree in Nursing.
• Master’s degree in business administration, healthcare administration, related field, a plus. Or applicable experience in a clinical or managed care environment.
• 3+ years of work experience in care management.
• Experience in program management and/or design or implementation
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Have knowledge around industry best practices and regulatory compliant reporting, preferred.
• Interpersonal skills with the ability to work in a fast-paced environment and health plan as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other collaborative tools.
• Ability to work on-site full-time at eternalHealth’s downtown Boston office.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email info@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

About the role: As a RN Cinical Care Manager in the Clinical Services Team with eternalHealth you will be a core member in the Clinical Services department at eternalHealth – whose responsibilities will include care management. You will work alongside a small team, reporting directly to the Head of Medical Management. This position will work towards meeting financial and operational performance goals and standards.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Collaborate on day-to-day clinical operations of the health plan, including complex care management, care coordination, disease management, and transition of care.
• Work on member- and provider-based interventions to improve quality and outcomes of care and reduce avoidable costs.
• Develop and refine clinically related compliance reporting and auditing activities.
• Work with a high performing team of clinical and non-clinical professionals that will deliver exceptional care while meeting quality and delivery targets.
• Follow eternalHealth’s strategic goals related to population health management and quality improvement, including setting and following the direction for analytics and existing quality measures.
• Interact regularly with executive team and department heads develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
• Ensures applicable Medicare (and any other LOB such as Mass Connector)requirements for clinical services activities and reporting are met.
• Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI) and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
•  

Requirements:

• Bachelor’s degree in Social Work.
• Master’s degree in business administration, healthcare administration, related field, a plus. Or applicable experience in a clinical or managed care environment.
• 3+ years of work experience in care management.
• Experience in program management and/or design or implementation
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Have knowledge around industry best practices and regulatory compliant reporting, preferred.
• Interpersonal skills with the ability to work in a fast-paced environment and health plan as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other collaborative tools.
• Ability to work on-site full-time at eternalHealth’s downtown Boston office.
• Licensed Social Worker.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email info@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

***$15,000.00 Sign-On Bonus***

About the role:

As the Director of Pharmacy with eternalHealth, you will report to the Chief Medical Officer (CMO) and be accountable for organizational leadership, performance, and operations for Pharmacy. This role offers the unique opportunity to be an integral part of eternalHealth’s growth and expansion initiatives in Medicare.

As the Director of Pharmacy, you will support the essential duties of eternalHealth to ensure we provide quality products and service for our members.

We provide a unique opportunity to be a part of a health plan in its beginning stages and by taking advantage of this rare opportunity, you will be able to have insight into all the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Own and manage day-to day pharmacy operations, clinical programs and strategic initiatives.
• Ensure Pharmacy meets all applicable regulatory, statutory rules and requirements.
• Manage and oversee relationships and contractual commitments with all key vendors (e.g. Pharmacy Benefit Manager) supporting Pharmacy.
• Develop and maintain Pharmacy benefit design in conjunction with other eternalHealth stakeholders.
• Partner with the CMO and clinical management to ensure best-in-class clinical support and quality initiatives, including Star measures.
• Create and maintain policies and procedures and desktop work instructions for Pharmacy.
• Participate in Annual Readiness activities.
• Support audit activities and Centers for Medicare and Medicaid Services (CMS) facing consultation.
• Accountable for Pharmacy key performance indicators (KPIs) to identify performance opportunities and trends.
• Communicate our brand, values, and differentiators effectively and accurately.
• Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.

Requirements:

• Bachelor’s degree required in Pharmacy.
• Active Pharmacist license.
• Minimum of 5 years of Managed Care, Pharmacy Benefit Manager (PBM) experience.
• Ability to work in-person from our Boston based office.
• Strong understanding of CMS requirements related to Medicare Part D operations and compliance.
• You’re a relationship builder and a team player.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Word, Excel, and PowerPoint.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Preferred:

• Medicare Part D health plan or PBM experience.
• Prior experience with CMS program audits and Part D reporting.
• Excellent organizational and program management skills.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process, please contact us separately, email human.resources@eternalhealth.com with the email subject “Reasonable Accommodations – [Applicant Name Here]”.

***** $15,000.00 Sign-On Bonus *****

About the role: As a VP, Compliance with eternalHealth, you will support the success of the implementation and maintenance of eternalHealth’s Compliance Program, which aims to prevent fraud, waste, and abuse, and exert oversight over first tier, downstream and related entities (“FDRs”). Reporting directly to the Chief Compliance Officer, you will be accountable for the Program, including performing annual updates and necessary corrective action plans to ensure regulatory compliance for all Medicare products.

Alongside eternalHealth leadership, you will provide the expert advice needed by our business leaders to formulate sound business practices that also meet regulatory requirements. This position will require you to develop and conduct oversight activities based on evolving risks. The role requires active participation in numerous committees and projects within eternalHealth, including the eternalHealth Compliance Committee. You will also work to identify opportunities for improvement and change while managing the Compliance Program’s budget and staff.

We provide a unique opportunity to be an influential part of a health plan still in its early stages, and you will have the unique ability to help shape company operations and be counted on to contribute the expertise that is required to run a successful and sustainable plan. Joining the leadership team of our startup requires flexibility, collaboration, and a commitment to challenging the status quo even though it often requires greater effort.

Responsibilities:

• Oversees development of all Centers for Medicare & Medicaid Services (“CMS”) submissions including, but not limited to, Part C/D reporting requirements, marketing materials, bid, etc.
• Assists business units with the development and maintenance of policies and procedures that fully comply with Medicare requirements using CMS manuals and audit guidelines.
• Ensures all policies and procedures are reviewed and approved annually, or more frequently as business or regulatory needs may require and are appropriately documented.
• Develops and contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards.
• Ensures compliance with eternalHealth policies and procedures, and governmental/accreditation regulations.
• Develops and coordinates a process to annually assess the compliance risk for internal business units.
• Issues and tracks corrective action plans as applicable.
• Develops and coordinates processes to routinely review and verify the implementation and status of Medicare compliance efforts as a part of the overall audit work plan.
• Establishes and maintains a positive working relationship with the CMS Account Manager. Acts as primary point of contact when responding to issues and inquiries from the Regional and Central Offices.
• Reports quarterly to the Board of Directors and to senior management regarding activities and concerns.
• Investigates and responds to complaints and reported incidents as may be required by CMS.
• Monitors CMS Health Plan Management System (“HPMS”) including correspondence, complaints, and submissions.
• Provides Compliance Department oversight and guidance to staff with respect to duties and day-to-day operations.
• Responsibility for CMS required training to business units and delegated entities, upon hire and/or initial contract, and annually thereafter.
• Responsible for the conduct, management, and day-to-day functioning of the Compliance Program.
• Remains current on all new Medicare laws and regulations that affect eternalHealth.

Requirements:

• Bachelor’s Degree in Healthcare Administration or related field; Master’s degree preferred.
• Track record of successful Compliance Program leadership for a Medicare Advantage Plan.
• At least 5 – 7 years of experience in Medicare Advantage compliance, or an equivalent combination of education and experience.
• Ability to apply compliance rules to day-to-day processes, working knowledge of federal health insurance regulations.
• Organizational skills with superior attention to detail.
• Communication, writing, and research skills.
• Proficiency in Microsoft Office with emphasis on Word and Excel.
• Effective coaching and mentoring of staff.
• Can motivate and lead multiple players around specific initiatives, encouraging teamwork.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email info@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

Accommodations – [Applicant Name Here]”.