Why This Role is Important to Us Under direction of the Sr. Director of Regulatory & External Audits, the primary focus areas of this position includes managing external audits and resulting Corrective Action Plan (CAP). This includes audits from external regulatory agencies including but limited to Centers for Medicare & Medicaid Services (CMS), Mass Health, Departments

Why This Role is Important to Us The primary focus areas of this position is managing compliance issues and regulatory responses including Corrective Action Plan (CAP) monitoring, investigations, validation activities, and issue management. Support the organization with assistance in interpreting regulations and providing education. Supervision Exercised No, this position

Why This Role is Important to Us The Senior Manager, IT Quality Assurance is part of the Business Solutions team responsible for QA testing, product management and solutions delivery. This role is the primary owner for the QA Managed Services program and will be critical in the definition and implementation of our Enterprise QA program to supports CCA's ability to serve o

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

The Provider Services Department provides a single point of contact for questions, problem solving, and access to care, for providers on behalf of members of the Senior Care Options (SCO) and One Care Programs. The Provider Services Representative II (PSR) position is responsible for providing accurate, prompt, and courteous service in response to written, electronic and

Interface with CCA's provider departments including credentialing, PDM, Provider Relations and Contracting Answer critical incoming phone calls from providers and respond to inquiries, concerns and questions about coverage, benefits, eligibility and authorization status Navigate through multiple, complex systems and screens while maintaining caller engagement Thoroughly d

The FWA Investigator Coder Sr. Associate is an integral part of the Fraud, Waste & Abuse (FWA) Special Investigation Unit (SIU). The position reports directly to the Sr. Director, Fraud, Waste & Abuse. This position utilizes a variety of FWA investigative tools and techniques to complete activities required to identify compliance with state and federal results, regulation

Why This Role is Important to Us The Privacy Analyst will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Manager, 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 develo

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

The Director, Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible for providing strategic leadership and oversight for the Quality & Control Assurance within CCA's Compliance department. This position designs, continually matures, promotes, & develops a program that adheres to all applicable federal, state, and contractual requireme

Why This Role is Important to Us The Director of Regulatory Compliance works directly with the Vice President Health Plan Regulatory Compliance/National Medicare Compliance Officer to develop and maintain an effective Health Plan Regulatory Compliance Program. This position is responsible for leading the development, implementation, and ongoing maintenance of elements of

System Administrator for GRC System System Administrator for GRC System Develop reports within the system for distribution among the organization Identify and scope needed system enhancements Work with vendor to correct identified issues Oversee the development and maintenance of system process documentation Work with training specialist to develop user tools Become subje

Why This Role is Important to Us The Senior Vice President, Internal Audit & Enterprise Risk Management (Remote) will lead the company's Internal Audit Program and activities as well as the organization's Enterprise Risk Management (ERM) Program and activities. The Internal Audit Program will employ a risk based approach in focusing audit resources on the highest risks wh