Start a career you'll love with eternalHealth!

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Community Care Manager with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include coordinating care among our various healthcare partners to ensure comprehensive support for our members. Working together with our Providers coordinating wellness opportunities.

This position will work towards meeting clinical, 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 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:

• Coordinating care among healthcare providers and services to ensure comprehensive support for our health plan members.
• Build relationships with the community healthcare systems to improve alignment with eternalHealth and foster growth.
• Actively perform and comprehensively document members and provider outreach and engagement activities to support complex care management, care coordination, disease management, and transitions of care.
• Perform comprehensive assessments of physical, emotional, psychosocial, and environmental needs of members and their caregivers.
• Create dynamic and fluid member-centered care plans to support health goals and improve health outcomes, continually evaluating for effectiveness.
• Work with Providers and the healthcare teams with HEDIS/STARS measures.
• Ensure members receive services that align with their benefit coverage and coordinate additional resources as required for holistic care.
• Follow and contribute to eternalHealth’s strategic goals related to population health management, quality improvement, and financial stewardship.
• 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.
• Other duties as assigned.

Requirements:

• Excellent working knowledge of the Healthcare network within the Bristol and Plymouth Counties
• Portuguese highly valued
• Up to 95% Travel within Bristol and Plymouth counties using personal vehicle
• Active RN License
• Bachelor’s degree in nursing or equivalent work experience
• 3+ years of work experience in Hospital based care management.
• 1+ years of Health Plan experience is preferred.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Exceptional interpersonal skills with the ability to work in a fast-paced environment as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including Microsoft Suite (Outlook, Excel, PowerPoint Word, etc.) and other collaborative tools.
• Valid MA Driver’s License
• A personal vehicle required for local travel

Salary Range: $85,000 – $120,000.

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 HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric health plan based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About this role:  The Provider Data Management Coordinator is responsible for maintaining the accuracy and compliance of provider data in accordance with internal, regulatory, and state requirements. This position ensures that provider databases are kept up to date, processes all necessary updates, produces essential reports, and supports functions related to network operations, quality assurance, and claims services.

• Key responsibilities include maintaining provider data accuracy and compliance.
• Updating provider databases.
• Generating essential reports.
• Supporting network operations, quality assurance, and claims services.

Key Responsibilities

• Database Maintenance: Add, update, and terminate provider records including demographic, credentialing, and contract information, ensuring data is processed both timely and accurately.
• Provider Outreach: Collaborate with Provider Representatives to conduct outreach to contracted providers as needed for roster updates
• Reporting: Generate regular status and compliance reports on a daily and weekly basis for internal and external stakeholders.
• Compliance Monitoring: Monitor provider data to ensure ongoing compliance with state regulatory requirements and internal company policies.
• Audit Support: Reconcile provider data, respond to audit requests, and verify that claims provider setup is accurate and complete.
• Administrative Duties: Maintain files, track data change requests, and provide statistical and analytical support as required.
• Data Accuracy: Ensure provider data remains accurate, current, and compliant with all requirements.
• Report Generation: Process updates and generate necessary reports related to provider database maintenance.
• Operational Support: Assist with network operations, quality assurance, and claims services.
• Primary Contact: Serve as the main point of contact for provider demographic changes, terminations, additions, reconciliations, and audit activities.
• Collaboration: Work closely with internal teams and external providers to ensure data submissions are timely and accurate.
• Auditing: Perform regular audits to verify provider data is accurate and complete.
• Policy Development: Assist in developing and implementing policies and procedures for effective data management.
• Training and Support: Provide training and guidance to internal teams on provider data management processes.
• Additional duties as assigned.

Qualifications and Skills

• High school diploma or equivalent required; Associate’s degree in a related field is often preferred.
• Experience in provider data management, network administration, or within a managed care environment.
• Strong attention to detail and excellent organizational skills.
• Effective communication and interpersonal abilities.
• Proficiency in data management software and related tools.
• Capability to work independently and collaboratively within a team.
• Familiarity with regulatory and compliance requirements related to provider data management.

Salary Range: $45,000 – $65,000

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.

Accommodation: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodation during the application process (which may include a job-related assessment) please contact us separately at HR@eternalhealth.com.

Care Manager

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Care Manager with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include care management. This position will work towards meeting clinical, 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 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:

• Actively perform and comprehensively document members and provider outreach and engagement activities to support complex care management, care coordination, disease management, and transitions of care.
• Perform comprehensive assessments of physical, emotional, psychosocial, and environmental needs of members and their caregivers.
• Create dynamic and fluid member-centered care plans to support health goals and improve health outcomes, continually evaluating for effectiveness.
• Ensure members receive services that align with their benefit coverage and coordinate additional resources as required for holistic care.
• Follow and contribute to eternalHealth’s strategic goals related to population health management, quality improvement, and financial stewardship.
• 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.
• Other duties as assigned.

Requirements:

• Active RN License
• Bachelor’s degree in nursing or equivalent work experience.
• 3+ years of work experience in care management.
• 1+ years of Health Plan experience is preferred.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Exceptional interpersonal skills with the ability to work in a fast-paced environment as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including Microsoft Suite (Outlook, Excel, PowerPoint Word, etc.) and other collaborative tools.

Salary Range: $85,000 – $120,000

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 HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric Medicare plan sponsor based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Clinical Pharmacist with eternalHealth you will be a core team member whose responsibilities will include supporting all activities in the Population Health Department. This position will work towards meeting financial and operational performance goals and standards. The clinical pharmacist is responsible for executing the daily activities associated with the clinical and operational components of the pharmacy benefit. This position reviews data, resolves issues, and coordinates tasks associated with pharmacy programs. This position also provides clinical support to interdisciplinary teams to improve healthcare outcomes, ensure patient safety, recommend cost-effective medication strategies, ensure compliance, and coordinate care efficiently and effectively.

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:
• Serve as subject matter expert and provide recommendations designed to address Medicare Part D associated Stars ratings
• Identify drivers of performance and cost and develop/execute plans to address those items in an effort to raise quality scores and lower plan spend
• Assist with oversight of clinical subcontractors
• Manage and oversee pharmacy benefits processing
• Assist with collaboration efforts with eternalHealth’s Third Party Administrator (TPA)
• Oversee Acumen data and report submission
• Participate in compliance and financial functions with the Medicare Compliance Officer and the Finance team
• Contribute to member and provider newsletters
• Formulary monitoring, oversight, and evaluation
• Complete comprehensive medication reviews
• Interact regularly with Population Health leadership and staff to develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
• 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 developing and implementing analytics and project planning for quality measures.
• Provide support for marketing materials
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI), Arizona DOI, and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
• Other duties and responsibilities as assigned.

Requirements:
• Doctor of Pharmacy or Bachelor of Science in Pharmacy
• Master’s degree in business administration or project management certification a plus
• 3 years of clinical experience
• 1+ years of Health Plan experience or Managed Care residency a plus
• Experience in program management and/or design or implementation
• Knowledge of CMS regulations
• 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 or based in Arizona.
• 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.

Salary Range: $95,000 – $136,000

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 HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

Care Coordinator

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Care Coordinator with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include supporting all activities in the Population Health Department. 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:

• Support departmental activities related to quality metrics (STARs) including day to day management of related workplans
• Assist with inbound and outbound member engagement including/not limited to scheduling appointments, documentation, information about care gaps, and information sharing
• Assist with oversight of clinical subcontractors
• Assist with management of pharmacy benefits
• Assist with collaboration efforts with eternalHealth’s Third Party Administrator (TPA)
• Interact regularly with Population Health leadership and staff to develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
• Work with a high performing team of clinical and non-clinical professionals that will deliver exceptional care while meeting quality and delivery
• Follow eternalHealth’s strategic goals related to population health management and quality improvement, including developing and implementing analytics and project planning for quality measures.
• Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company
• 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.
• Other duties and responsibilities as

Requirements:

• Associate or bachelor’s degree in healthcare
• Master’s degree in business administration, healthcare administration, related field, a plus. Or applicable experience in a clinical or managed care
• Experience in project management and/or design or implementation
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Have knowledge around Health Care/ Health Plan industry best practices and regulatory compliant reporting, a Plus.
• Interpersonal skills with the ability to work in a fast-paced environment 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
• Excellent written and communication
• Creative, strategic, and continuously striving for
• Flexible and able to ramp-up quickly on different projects 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.
• Ability to participate at Member events/eH events throughout Massachusetts.
• Bilingual, fluent in Spanish a plus

Preferred:

Valid MA Driver’s License

A personal vehicle for travel within Massachusetts

Salary Range: $55,000 – $78,000.

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 HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.