Why This Role is Important to Us The Nurse Utilization Management (UM) Reviewer is responsible for day to day timely clinical and service authorization review for medical necessity and decision making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations.

Why This Role is Important to Us Under direction of the Compliance Manager, , the primary focus of this position is the day to day coordination of oversight activities for CCA's First Tier, Downstream, Related Entities (FDR) and Medicaid Material Subcontractors (MS), also known as the FDR MS Program. This includes review of contract and policy documents, coordinating atte

Why This Role is Important to Us This is a key leadership role that will provide oversight of CCA's multi state Mail Operations. The Mail Operations Manager is responsible for being CCA's subject matter expert for all postage and mailing activities. The Mail Operations Manager ensures compliance with business requirements and with all US Postal Service regulations on post

Why This Role is Important to Us The Executive Administrator will serve as a critical contributor to the workings of the Chief Revenue and Growth officer and his direct reports including the connection and management of many critical components of the organization. In addition, the Executive Administrator will support the General Manager, Market Lead Massachusetts. What Y

Why This Role is Important to Us The Manager, Privacy will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Director, the role will ensure that the organization complies with relevant and applicable privacy laws, regulations, contractual requirements, and standards. The role will be responsible for deve

Why This Role is Important to Us The Director, Privacy will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Chief Privacy Officer, the role will ensure that the organization complies with relevant and applicable privacy laws, regulations, contractual requirements, and standards. The role will be respon

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Why This Role is Important to Us The Specialist, Quality Provider Engagement ACO/PO monitors Quality Measures within Accountable Care Organization physicians' offices for Group Practice Reporting Options (GPRO). Conducts onsite reviews and audits for Medicare compliance. This position partners with providers to support in office improvement efforts aimed at increasing the

Why This Role is Important to Us The Provider Contract Manager is responsible for developing, negotiating and managing contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost effective providers of healthcare services. What You'll Be Doing Develop, negotiate and maintain provider contracts for

Why This Role is Important to Us CCA partners with the Commonwealth of Massachusetts to provide supportive temporary emergency shelter to families under the Executive Office of Housing and Livable Communities' Emergency Assistance program. Our shelter program is part of the Commonwealth's response to a rapidly growing number of unhoused families, including thousands of fa

Support IT communications Review documentation and provide feedback on quality and accuracy Research new ways to conduct business operations Research new technologies and its applicability Provide ideas to resolve risks and issues to IT leadership team Participate in learning and development Maintain active career development plan What We're Looking For Education Bachelor

Develop and maintain relationships with IT, business units and vendors to identify potential opportunities (projects and programs) to improve business operations, and deliver business outcomes. Consult with business unit's and review IT usage, services, technology, and department specific projects. Identify, forecast and develop IT needs. Establish subject matter expertis

Why This Role is Important to Us Commonwealth Community Care's (CCC) Primary Care NP/PA provides comprehensive primary care consultation and management to adults of all ages, familiar with those who have complex physical, developmental, intellectual, and behavioral health conditions, requiring medical evaluation and care. Care is delivered in the office, home, and crisis

Why This Role is Important to Us Commonwealth Community Care's (CCC) Primary Care NP/PA, BOS/SPR provides comprehensive primary care consultation and management to adults of all ages, familiar with those who have complex physical, developmental, intellectual, and behavioral health conditions, requiring medical evaluation and care. Care is delivered in the office, home, an