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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.

Based Salary + Uncapped Commission

Massachusetts Service Area

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 field Medicare Field Sales Representative with eternalHealth you will help execute the sales strategy that effectively brings eternalHealth products and services to market, responsible for the direct outside sales to beneficiaries and reports to the Director of Sales for their region. The Outside Medicare Sales Representative will be responsible for contacting assigned leads, generating lead opportunities, hosting educational and sales events, partnering with identified key providers and achieving sales goals.

Responsibilities:

· Meet or exceed sales expectations and drive membership growth throughout the year by acquiring new members and maintaining a high level of retention.

· Work directly with community-based organizations, sales locations, contracted providers and other sources to develop self-generated referral channels, resulting in increased enrollments.

· Identify prospective members and educate them on the available benefit plans and features that are tailored to the beneficiary needs and eligibility.

· Ensure a superior customer experience through steady and timely service, follow-up and plan benefit reviews with prospects and members.

· Ensure all documentation is complete, comprehensive, clear and appropriately filled out including enrollment application, scope of appointment, health risk assessments and other applicable forms.

· Ensure CMS compliance with all sales, events, and enrollments.

· Other related duties and tasks as assigned

Requirements:

· Must have insurance brokers license valid in Massachusetts (resident or non-resident).

· 2+ years in sales experience in roles successfully selling in the Medicare Advantage market.

· Mission focused, with excellent communication and interpersonal skills.

· Strong technical skills, including with Microsoft Suite – Excel, PowerPoint, Project, etc.

· Flexible and able to ramp-up quickly on different projects to support and lead 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.

· Valid Driver’s License and automobile

Preferred:

· Bachelor’s degree in relevant field of study (e.g., Business Administration, Marketing, Sales, Communications, Public Relations etc.

· Experience in marketing and sales, and/or in start-ups, tech, healthcare or insurance is a plus.

· Bi-Lingual in English and Spanish.

Salary: $65,000 – $80,000 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, 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.

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, and our providers.

About the role: As a Community Relations Representative with eternalHealth you will help execute the sales strategy that effectively brings eternalHealth products and services to market, responsible for identifying and building relationships within the community, leading to increased enrollment and retention. The Community Relations Representative will be responsible for engaging beneficiaries and community organizations to generate new and nurture continuing relationships in their assigned markets.

Responsibilities:

• Achieve assigned target new lead goals by meeting minimum expectations of community events and outreach, which will directly lead to membership growth throughout the year.
• Develop a community engagement strategy and calendar, including end-to-end event planning and facilitation.
• Facilitate member educational events including but not limited to Annual Notice of Change and Member Appreciation events.
• Serve as the primary contact for the health plan at community health fairs, events and meetings.
• Identify and develop relationships with healthcare stakeholders including but not limited to; providers, faith-based leaders, government employees, elected officials, and community leaders.
• Serve as a resource to the sales department on subject-matter expertise and contributes to and manage medium to large projects as assigned.
• Ensure CMS compliance with all sales, events, and enrollments.
• Other related duties and tasks as assigned

Requirements:

• 3+ years of sales experience in roles related to community relations, business enablement and outside inquiry generation.
• Mission focused, with excellent communication and interpersonal skills.
• Strong technical skills, including with Microsoft Suite – Excel, PowerPoint, Project, etc.
• Flexible and able to ramp-up quickly on different projects to support the sales 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.
• A reliable, insured personal vehicle required for Massachusetts travel
• Valid MA Driver’s License     

Preferred:

• Bachelor’s degree in relevant field of study (e.g., Business Administration, Marketing, Sales, Communications, Public Relations etc.
• Professional working proficiency in Spanish and /or Portuguese languages is a plus.
• Experience in marketing and sales, and/or in start-ups, tech, healthcare or insurance is a plus.

Salary Range: $75,000 – $105,000 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.

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