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. eternalHealth is a consumer-centric, start-up Medicare Advantage Health Plan based in Boston. We are committed to creating long-lasting partnerships with our members, our providers, and you!

Role Overview

Reporting to the CMO of eternalHealth, the Director of Quality is responsible for the design, implementation, monitoring, and continuous improvement of the eternalHealth Quality Management Program. This role ensures compliance with all applicable CMS regulations, accreditation standards, and state Department of Insurance (DOI) requirements. The manager partners across departments, providers, and delegated entities to drive performance on HEDIS®, CAHPS®, STAR Ratings, and other quality measures, while promoting a culture of clinical excellence, compliance, and member-centered care.

Key Responsibilities

Program Leadership & Oversight

· Develop, implement, and oversee the annual Quality Management Program Description (QMPD), Work Plan, and Annual Evaluation.

· Coordinate and facilitate Quality Management Committee (QMC) activities.

· Monitor compliance with federal, state, and accreditation requirements impacting quality initiatives.

Quality Improvement & Performance Management

· Lead initiatives to improve HEDIS®, CAHPS®, HOS, and STAR Rating measures.

· Partner with internal teams to design interventions addressing care gaps, disease management, and preventive health.

· Develop dashboards and reports to track progress and present findings to leadership.

Regulatory Compliance & Accreditation

· Ensure adherence to CMS Quality Improvement Project (QIP) requirements.

· Prepare for any accreditation surveys, CMS audits, and state DOI reviews.

· Maintain documentation and evidence to demonstrate program compliance.

Provider & Delegated Entity Engagement

· Collaborate with providers and delegated entities to ensure quality obligations are met.

· Develop provider education and training programs related to quality performance.

· Participate in joint operating committees with delegated groups.

Team & Cross-Functional Collaboration

· Work cross-functionally with Compliance, UM, Risk Adjustment, Member Services, and Population Health.

· Engage members through outreach programs to improve satisfaction and STAR performance.

· Other duties as assigned.

Qualifications

Education & Experience

· Bachelor’s degree or equivalent in nursing, Healthcare Administration, Public Health, or related field required.

· Minimum 5 years of experience in healthcare quality management; 2 years in Medicare Advantage or managed care.

· Strong knowledge of CMS Part C/D regulations, STAR Ratings, HEDIS®, CAHPS®, and NCQA/URAC standards.

Skills & Competencies

· Proven ability to design, implement, and evaluate quality improvement programs.

· Strong analytical and data-driven decision-making skills.

· Excellent written and verbal communication skills.

· Strong project management and organizational skills.

· Ability to collaborate with providers, vendors, and internal teams.

Salary: $165,000 – $205,000 per year

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 at HR@eternalhealth.com.

Controller

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 the role: We are seeking an experienced and detail-oriented Controller to join our team at our rapidly growing health insurance company. The successful candidate will be responsible for managing all aspects of financial management, including corporate accounting, internal financial reporting, annual audits, statutory and GAAP reporting to regulators, as well as development/maintenance of internal control policies and procedures. Reporting to the Chief Financial Oficer, the Financial Controller will also manage relationships with outside vendors and regulatory organizations. This is a hands-on managerial role, with the ideal candidate being adept at both overseeing the accounting function and leading a small team of accountants.

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 diferent roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Key Responsibilities:

· Oversee all accounting activity for the company.

· Provide leadership to financial department staff, including the Senior Accountant and Staff Accountant roles.

· Provide oversight of the month-end close process and bi-weekly payroll process.

· Prepare and analyze monthly, quarterly, and annual reports to ensure financial information has been recorded and reported in compliance with established policies and procedures.

· Develop and document business processes and accounting policies and procedures, to maintain and strengthen internal controls.

· Prepare timely and detailed reports on financial performance on a monthly, quarterly, and annual basis.

· Prepare financial reports according to both GAAP and STAT accounting principles and explain diferences to regulatory bodies and internal leadership.

· Collaborate with external auditors and provide internal leadership to both STAT and GAAP audits.

· Comply with local, state, and federal government regulatory and reporting requirements.

· Provide staff support to the company’s Audit – Finance Committee.

· Liaise with Board members, presenting financial information in an understandable and actionable manner.

· Provide input and support to other key business functions that afect the company’s financial performance, e.g., risk adjustment program, CMS bid process, etc.

· Maintain strong, positive relationships with federal and state regulators.

· Other duties as assigned.

Requirements:

· Bachelor’s degree in Finance, Accounting or related field. A Master’s degree or Certified Public Accountant (CPA) certification would be preferred.

· Proven experience as a Financial Controller or relevant role, within the health insurance sector.

· In-depth knowledge of GAAP and STAT accounting principles, and general risk management practices.

· Excellent knowledge of data analysis and forecasting methods.

· Proficient in the use of MS Ofice and financial management software.

· Ability to manage, guide, and lead employees to ensure appropriate financial processes are being used and to support the professional growth of the team.

· Highly analytical, with a strong numerical aptitude and problem-solving skills.

· Strong interpersonal and communication skills.

· Ability to work at eternalHealth’s downtown Boston office either full time if on-site or periodically if remote / hybrid.

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 ofer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Work Environment: This job operates in a professional ofice environment. This position routinely uses standard ofice equipment.

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 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. eternalHealth is a consumer-centric, Medicare Advantage Health Plan based in Boston. We are committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As the VP 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 VP of Pharmacy, you will support the essential duties of eternalHealth to ensure we provide quality products and services 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:

· Drive action-oriented strategy to help health plan achieve Part D Quality/STAR Measures 4 STAR or Higher.

· Help to optimize the Pharmacy Portion of the Medical Loss Ratio through the right programs and initiatives

-Step therapy and

-Comprehensive Medication Review- steering to lower cost alternatives.

· Oversight of OptumRx

· GLP-1 Action Plan- High-cost drug action plan

· Strategic Product Planning Assistance, to create competitive and financially viable products.

· 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.

· Other duties as assigned.

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:

· Solid Medicare Part D health plan or PBM experience.

· Prior experience with CMS program audits and Part D reporting.

· Excellent organizational and program management skills.

Salary: $155,000 – $245,000 per year

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 at hr@eternalhealth.com.

HR Coordinator

eternalHealth – The Next Generation of Medicare Advantage

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

About the role:

As our Human Resources Coordinator, you’ll be the heart of our HR operations, keeping our processes running smoothly and ensuring every employee’s journey with us starts on the right foot. From managing personnel files with precision to guiding new hires through orientation, your work will directly shape the employee experience and help maintain a culture of trust, compliance, and growth. The Human Resources Coordinator will be responsible for performing HR-related duties on a professional level and working closely with the HR Lead in supporting the organization.

We provide a unique opportunity to be a part of a health plan in its beginning stages. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and they are passionate about sustainable change.

Responsibilities:

· Maintain accurate and confidential personnel files in compliance with legal and company requirements.

· Administer the full recruiting process—from posting job openings to coordinating interviews, managing candidate communications and timely reporting administration.

· Oversee background check administration, ensuring timely and compliant completion for all new hires.

· Plan and facilitate employee start and company-wide orientation sessions to welcome and onboard new employees.

· Ensure completion of new hire and annual HR trainings.

· Daily administration of the work from home calendar requests.

· Front office administration, greeting guests, receiving, and distributing mail, ordering office supplies and catering as needed.

· Ad hoc administrative functions and special projects as needed.

· Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.

· Other duties as assigned.

Requirements:

· Bachelor’s degree in relevant field of study or equivalent work experience.

· 2+ years of HR coordination, administration, or related experience.

· Strong organizational skills and meticulous attention to detail.

· Excellent communication skills, with the ability to engage employees at all levels.

· 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 perform job functions while maintaining compliance with all State and Federal regulations.

· Experience with ADP WFN preferred.

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”